Total knee arthroplasty in the Niger Delta, Nigeria: Preliminary report and lessons learnt

Background: Total knee arthroplasty is the treatment of choice for patients with debilitating knee pain secondary to severe osteoarthritis. The procedure is yet to be commonplace in Nigeria due to socio-cultural and financial constraints.Aim: To review the pattern of presentation and our experience in total knee arthroplasties in a private hospital in Port Harcourt, Nigeria.Methods: A retrospective review of all patients who had total knee replacement (TKR) from February, 2013 to June, 2017 at a private health facility in Port Harcourt, Rivers State. The INDUS knee was utilized in all the patients. Data was analysed by descriptive statistics.Results: Forty-five total knee replacements (TKR) were done on thirty-eight patients , seven patients had bilateral TKR's. Male to female ratio was 1: 2.45. Mean patient age was 60 years. Majority presented with bilateral knee pain (55.3%). Fourteen had angular deformity while four had bonedefects. Kellgren-Lawrence radiologic grade was 4 for almost all the patients. Average duration of surgery was 107 mins. Mean post-operative  hospital stay was 58 days. Twenty-nine patients had significant improvement in functional knee indices. There were three deaths. Total  postoperative complication rate was 31.1%. Most were followed up for between six and 36 months.Conclusion: There is a gradual but definite increase in total knee arthroplasty surgeries in Nigeria. Regular audit and changes in government policy concerning health insurance and medical tourism will enhance our practice. Keywords: knee, arthroplasty, osteoarthriti