1. Dr. L. K. Lelei Specialist Orthopaedic Surgeon Moi University, School of Medicine

2. Introduction Total hip replacement is the most successful and cost effective operations performed at present time. Aims to relieve pain and increase mobility and function of a damaged joint. Success rate of over 90% Mainly done in the elderly.

3. Principles and considerations Prosthetic implant must be durable It must permit extra ordinary low friction movement and articulation It must be firmly fixed to the skeleton Selection of prosthesis and fixation technique depends on patient’s bony structure, joint stability and other individual characteristics.

4. Surgical treatment options Joint preserving operations Arthroscopy Cartilage transplantation Osteotomy Arthroplasty Options: Hemiarthroplasty Resurfacing arthroplasty Total joint arthroplasty

5. Indications for THR i. Arthritis (Rheumatoid, Juvenile and ankylosing spondylitis) i. Degenerative joint disease (primary and secondary) i. Osteonecrosis (post fracture or post dislocation) i. Non union following fracture neck of femur i. Hip fusion with pseudoarthrosis i. Bone tumor involving proximal femur or acetabulum

6. Contraindications Absolute Unstable medical illness that would significantly increase risk of morbidity and mortality Active infection of hip joint Relative Any process that is rapidly destroying bone e.g. neuropathic joint Insufficiency of abductor musculature Progressive neurological disorder.

7. Outcome Measures Oxford Hip/ Knee Score WOMAC SF12 / 36 Harris Hip Score / KSS New Zealand Priority Score EQ-5D Visual Analog scores.

8. Shift in Focus of Outcome Past research focused on surgical/technical aspects of surgery Recent research uses more patient-centered outcomes less expensive, less time intensive and reduce the number of patients lost at follow-up because they do not require a clinic visit.

9. Complications of Joint Arthroplasty Early complications Recurrent dislocation Infection Implant failure Intra-operative fracture Late complications Wear of bearing surface Osteolysis Mechanical loosening Peri-prosthetic fracture

10. Signature implants Are non cemented. Associated with excellent intermediate to long- term results. Excellent survivorship figures have been quoted of up to 99.1% at 10 years

12. Patients and Methods 31 patients done total hip arthroplasty using signature implants January 2014 and December 2015. Mean age of the patients was 54.6 (Range of 17 to 84 years) Average length of hospital stay was 9days Average cost was 524, 654 Kenyan shillings. Majority of the patients presented with severe pain on the hip.

13. Cont’ Oxford hip score was used to evaluate the functional outcome. Patients followed up were done total hip replacement between January 2014 and December 2015. 77.4% of the patients done THR responded to OHS

14. Radiological images

16. Bilateral hip replacement

17. Fused hip converted to THR

18. Demographics N= 31 Percentage Age (yrs) Mean54.6 Side (%) Left1651.6 Right1341.9 Bilateral26.5 Gender Male722.6 Female2477.4

19. Gender distribution

20. Laterality of THR

21. Indication for THR

22. % of patients in each scoring category ScoreOHS(%) N=24 51 - 6017 41 - 506 31 - 401 21 - 300 12 - 200 OHS=Oxford Hip Score Score of 60= No Disability, 12= Maximum Disability

23. Discussion The global burden of chronic disease, including OA and other joint disease is on the increase. Joint replacement has proved to be beneficial with documented success rate of over 90% It improves function, decreases pain and increases quality of life and satisfaction Joint arthroplasty is now gaining popularity in Kenya.

24. Cont’ The number of THR being done is increasing gradually over the years. Majority of the cases done were female accounting for 77.4% Functional outcome basing on the patient reported measures was satisfactory with mean score of 52.

25. DVT Prophylaxis Prophylaxis Pradaxa (dabigatran etexilate) 220mg once a day Administered for 4 weeks in THR.

26. Prophylactic Antibiotics Ceftriaxone 2g at induction of Anaesthesia, and continued for 24-48 hours. Patients are started on Clindamycin 300mg – 600mg post op and continued for 1-2-weeks

27. Conclusion THR replacements are commonly performed and highly successful operations. Most THRs last 10-15 years or more. With good surgical technique, sound implant design and patient compliance with rehabilitation, the outcome is satisfactory.