Etiology, Common Practices and Early Complications of Primary Total Hip Arthroplasty in Kenya

Abstract

Background: PTHA has transformed from its original invention to the current state. Etiologies leading to PTHA have shifted from the original primary osteoarthritis to include other etiologies due to improvement in implant designs and surgical techniques. In Kenya, the trends have shifted too, particularly, in keeping with the modern world despite various challenges. This study sought to find out the current state in respect to etiology, how the procedure is currently undertaken, and associated early complications. Similarly, the approaches, cementing techniques and type of antibiotic prophylaxis used by various surgeons in Kenya. Study objective: To establish the etiology, current common practices and early complications of doing PTHA in Kenya. Study design: Cross-sectional descriptive study. Study setting: A Multi-center study was conducted in various orthopedic wards and hospitals in Kenya (Kenyatta National Hospital, AIC Kijabe mission Hospital, Kikuyu mission Hospital, Coast General Hospital and Meru County Teaching and Referral Hospital). Study population: All age groups of patients consenting for the study and admitted for Primary total hip arthroplasty at the study centers during the study period (November 2019 - March 2020). Methodology: Quantitative primary data was collected based on institution workload and recorded in data collection sheets. Data analysis: Statistical analysis was performed with commercial software (SPSS 23).Descriptive analysis was done to determine the frequencies and proportions of the variables and presented accordingly. Univariate analysis was conducted to determine any associations. Utility: The data and information acquired from this study have provided information on current state of PTHA and will act as a comparison in PTHA practices with the rest of the world. Results: A total of 84 patients were recruited in the study from the five centers between November 2019 and March 2020,the mean age was 59 years(15-90 years).Majority were females(63.1%).The

commonest hip involved was the right(50%).Most of the patients ( 47.6%) etiology was primary OA. Cementless was the most common implant used (51.2%).Spinal block (78.6%) was the commonest anesthesia used. Ceftriaxone (70.2%) was the commonest antibiotics preferred at induction of anesthesia and as a continuation antibiotic. The commonest (66.7%) approach was lateral. Non-vacuum mixing was the preferred (82.9%) technique with most of the surgeons using bone block (70.7%) during plugging. Leg length discrepancy (15.5%) were the commonest early complication after PTHA procedure with 94.0% of the patients having no complications. Discussion: The study established that, a relatively younger subject as compared to the western world undergo PTHA but comparable to Asiatic countries despite being higher than other African countries. The female gender was more prone to OA which is the commonest etiology found. This may be attributed to an increase in life expectancy in the last few decades in Kenya. Relatively, younger subjects undergoing PTHA may have been the reason why cementless implants preference was established in this study. The use of spinal block anesthesia found to be more common in this study is probably due to preference. The same finding globally of ceftriaxone as the preferred induction antibiotic was also noted in this study. The approach commonest used in our setup was lateral, probably due to surgeon’s training. The study finding of non-vacuum cement mixing, cement delivery by finger packing and plugging by bone plug as the preferred technique shows that we are almost catching up with the developed world. Conclusion: The etiologies leading to PTHA varies slightly in terms of frequency in comparison to the western world and Asiatic countries but similar to the rest of Africa. We somehow have managed to keep up with the developed world in terms of employing some of the latest techniques in various centers. Recommendations: Formation of a national hip registry will come in handy in keeping our records and also for quick retrieval of the same. Formulation of national guidelines on PTHA may also provide a national guideline on PTHA practices.