Total hip arthroplasty in sickle cell disease patients in a developing country.

BACKGROUND: Osteoarthritis secondary to osteonecrosis of the femoral head is a common presentation in patients with sickle cell disease. Functional limitations with or without deformities from these complications of sickle cell disease often require Total Hip Arthroplasty (THA) to improve outcome. AIM: The aim of this study was to evaluate the postoperative outcome of THA for secondary osteoarthritis from osteonecrosis of the head of the femur in patients with sickle cell disease. Methodology: A retrospective study of outcome of THA in sickle cell disease patients between January 2010 and December 2015 is presented. Primary outcome was measured using the rates of complications and the Harris Hip scores at 6 weeks, 12 weeks, 6 months, and yearly. RESULTS: A total of 68 THA in 56 patients with sickle cell disease was reviewed. The age range was 13-68 years, with a mean of 30.9 years. There were 15 males and 41 females (M: F ratio = 1:3). Approaches to the hip were direct lateral (64.3%), anterolateral (1.8%), and posterior (33.9%). 12 (21.4%) patients had bilateral total hip arthroplasty, and 44 (78.6%) had unilateral total hip arthroplasty. No patient required adductor tenotomy. Superficial surgical site infection was recorded in 7 (12.5%) patients. The postoperative functional outcome, measured by the Harris Hip score, was good or excellent in all patients, except 2 (2.9%) who required revision surgery following unacceptable results after primary hip arthroplasty. CONCLUSION: THA is a viable and effective treatment modality for sickle cell disease patients with osteonecrosis and secondary hip osteoarthritis. The choice of surgical approach does not affect the outcome.

A Review of Total Hip Arthroplasty and Post-Operative Functional Hip Scores in National Orthopaedic Hospital,Lagos.

BACKGROUND: Hip pain that severely limits functional activity, and unresponsive to other measures of treatment is the major indication for Total Hip Arthroplasty. Hip scores are used to access functional outcome, by comparing pre-operative and post-operative scores. STUDY DESIGN: The aim of this study was to investigate the overall functional outcome after Total hip Arthroplasty, and compare results between two approaches to the hip (Direct lateral and Posterior approach). A retrospective study of 56 total hip arthroplasty between January 2011 and September 2013. Pre-operative and Post-operative functional hip scores were assessed using the Harris Hip Score. Functional and clinical outcome of surgery was compared between two approaches to the hip. RESULTS: Approach to the hip was 61% for direct lateral and 39% for posterior approach. Superficial surgical site infection was recorded in 10 cases, 7 of these were in patients who had direct lateral approach. Post-operative HIP Score was excellent in 41%, and good in 52% of cases with a mean assessment at 6 weeks. CONCLUSION: The post-operative functional status, measured by the Harris Hip score, was satisfactory in over 90% of cases. There was no statistically significant difference in Harris Hip Scores in the two approaches (p>0.05).

Adverse effects of nickel in transosseous wires and surgical implants: literature review.

INTRODUCTION: Transosseous wires used in the management of fractures are stainless steel alloys which contain nickel 14.5%, chromium 17.6%, iron 62.5% and molybdenum 2.8%. Gradual disintegration of the transosseous wires release nickel into the blood leading to increase nickel concentration in the blood. Nickel has been found to have some adverse systemic effects on the body. The aim of this paper is to discuss the sources of Nickel in the body as well as the systemic adverse effects of Nickel as a degradation product of stainless steel surgical implants. METHODS: A study of pertinent literature on nickel as a content of stainless steel alloy used in implant surgery was done, taking note also of other sources of nickel in the body, the toxicokinetics of nickel and the related adverse effects of this metal and its compound in humans. RESULTS: As outcome,the sources of human exposure to nickel,distribution and metabolism of nickel in the body, host responseto stainless steel wires and the adverse effects of nickel in the body are presented. CONCLUSION: It may be necessary to discourage the use of wires or implants containing nickel in the management of fractures.The need for removal of these implants after they have served their purposes is emphasized.

Profix cemented total knee replacement: a 5-year outcome review from Lagos, Nigeria.

BACKGROUND: Total knee replacement is a standard treatment for severe osteoarthritis of the knees. It is however, still a novel procedure in Nigeria. Literature on the procedure and outcome of management are sparse in Nigeria. OBJECTIVE: This study aimed at describing Total Knee prosthetic Replacement as it is practiced in National Orthopaedic Hospital, Lagos. METHODS: Data on patients treated with Total knee replacement between 2006 and 2010 were analyzed retrospectively. The standard anterior approach, with a medial parapatellar incision under pneumatic tourniquet was used in all cases. RESULTS: There were a total of 59 knees in 48 patients operated, with a female: male ratio of 5:1. Patients were in the sixth to ninth decades of life. There was a statistically significant relationship between duration of symptoms and severity of angular deformity. The average pre-operative Knee score (KS) was 27 and average function score (FS) was 43. Average duration of surgery was 126.38 minutes. Tourniquet removal after wound closure was associated with reduced intra-operative blood loss (p < 0.05). Post-operative complications included peri-prosthetic fracture (1.69%), post-operative anaemia (8.47%), superficial wound dehiscence (3.39%) and foot drop (3.39%). The mean post-operative KS and FS increased to 80 and 75 respectively. CONCLUSION: Total knee replacement, though a novel procedure in our institution is beneficial to patients with severe osteoarthritis. A long term outcome study is being planned.