Factors Influencing Choice of Implants in Primary Total Hip Replacement in Kenya: a Multicenter Study

Abstract

Background: Hip replacement surgery has been very successful in the management of debilitating hip conditions that have failed to respond to conservative management. The choice of implants is based on multiple factors, including patient factors such as anatomical and functional demand, surgeon factors, cost, and availability of implants. It is essential to understand the characteristics of implant design fully, the cost, and the availability of implants to understand the reason for the choice of each implant. Understanding these factors would help standardize and optimize implant selection for patients, thus improving clinical outcomes. Broad Objective: To identify the factors influencing the choice of implants in primary hip replacement in Kenya. Study design and site: This was a multicenter cross-sectional study carried out at Kenyatta National Hospital, Nakuru Level 5 hospital, Mombasa level 5 Hospital, Aga Khan University Hospital, Nairobi Hospital, MP – Shah Hospital, Mater Hospital, PCEA Kikuyu hospital, and Kijabe Mission Hospital. Participants and Methods: Through convenient sampling of 345 procedures of primary and secondary osteoarthritis and hip conditions that had failed conservative management and undergoing hip replacement surgery were selected, and surgeons undertaking the procedures interrogated on factors determining the choice of implant. A structured data collection tool was used. 9 Study results: The mean age of the study participants was 55.5 years, SD 9.84, median 56 years, range 38 – 75 years. Females represented 58% compared to 42% who were males. Indications of hip replacement were osteoarthritis in 187 (54.2%), fracture neck of femur in 76 (22%) patients, and avascular necrosis of the hip in 35 (10%). Others included rheumatoid arthritis 25 (7.3%) and dysplastic hip 22 (6.4%). According to the surgeons, the cost was the most common factor at 47%, followed by quality of bone at 28%, age at 15%, surgeon preference at 8%, and availability at 2%. Conclusion: The choice of implant is greatly influenced by cost, bone quality, age, and level of activity of the patient. Efforts should be made to reduce the cost of an implant. This would help optimize the selection of implants in patients. Guidelines on hip replacement are needed to help surgeons and patients in clinical decision-making.