Acetabular reconstruction using a cage in complex primary total hip replacement in a developing country: An assessment of early functional outcome.

BACKGROUND: Acetabular reconstruction following bone loss is a major challenge facing the arthroplasty surgeon. Traditionally, the armamentarium for the treatment of large bone defects (Paprosky Type 2C or 3) included antiprotrusio cages (APC). The aim of this study is to determine the pattern of presentation and assess the early functional outcome of patients who had undergone acetabular reconstruction using APC in complex primary total hip replacement (THR). PATIENTS AND METHOD: Between November 2008 and November 2015, 38 THR were carried out in 35 patients who required acetabular reconstruction, at Davidson and Judith Consultants Clinics Enugu, Nigeria. RESULTS: There were 25 males and 10 females, with a ratio of 2.5:1. The average age of the patients was 61.33 ± 6.92 with a range of 56 to 72. The mean pre-op Harris score was 49.02 ± 2.3.The mean post-op Harris hip score (HSS) was 88.75 ± 10 (P < 0.001) at one year and 92.25 ± 13 (P < 0.001) at 5 years. The etiology showed that most (52.63%) of our patients had primary osteoarthritis with Type 3 acetabular defect. Two (5.26%) patients had the following complications: dislocation (2.63%) and screw breakage (2.63%). The minimum follow-up period was 5 years. DISCUSSION: After follow-up at 1 year and 5 years, the hips showed significant improvement concerning pain, gait, and mobility based on HHS and were able to return to their various professions. CONCLUSION: APC provides a satisfactory solution for patients who present with acetabular deficiency in complex primary THR.

Total knee replacement in Nigeria: An assessment of early functional outcome of 68 consecutive knees.

BACKGROUND: Although there are many methods of treatment for knee osteoarthritis (OA), total knee replacement (TKR) is a very effective way of managing this condition as it improves function and alleviates pain with a consequential improvement on quality of life of patients. To our knowledge, no comprehensive study of the outcome of TKR has been published in our environment, hence the need for a study of our TKR outcomes. OBJECTIVES: The aim of this study is to describe the pattern of presentations of our patients with knee OA who have undergone TKR, assess the outcome, and identify any variables that affect the outcome. PATIENTS AND METHOD: Between November 2008 and November 2013, 68 TKRs for treatment of end stage arthritis were carried out for 52 patients. All the patients were implanted with the same prosthesis design (DePuy and Biomet) and had posterior cruciate substituting knee. The average follow-up was 5 years. The preoperative and postoperative Oxford knee score (OKS) was used for outcome measurement at 1 and 5 years. RESULTS: There were 20 males and 32 females (M:F ratio = 5:8). The mean age of the patients was 63.54 ± 0.62 with a range of 55 to 77. There were 18 (26.47%) valgus knees with a mean angle 22.07° ± 5.73°, 12 (17.65%) varus knees with a mean angle 14.69° ± 2.84°, 8 (11.77%) knees with flexion deformity with a mean angle of 10.2° ± 1.32°, and 30 (44.11%) knees had no deformities at all. The variables like deformities, comorbidities, gender, side-affect, and occupation did not affect the outcome (P > 0.05). At 1 year and 5 years, there was no radiological evidence of osteolysis, loosening, or component subsidence. CONCLUSION: Despite the deformities and comorbidities, our patients presented with quality of life improved based on the improved OKS of the patient. We recommend a well-planned meticulously executed TKR for patients with debilitating OA in our environment.