Anaesthetic and Surgical Experience from Joint Replacement Therapy in a Teaching Hospital in Makurdi, Nigeria

Joint replacement therapy (JRT) commonly performed in advanced countries is being introduced in some developing countries. The objective of this study was to assess anaesthesia used and the outcome of the first 17 cases performed at a young teaching hospital in Nigeria. This was a cross-sectional descriptive study of patients for JRT at Benue State University Teaching Hospital, Makurdi, Nigeria from 23/6/2014 to 31/8/2016. Data analyzed from the anaesthetic/surgical records included age, sex, ethnicity, ASA classification, Ficat and Arlet classification of avascular necrosis, Gardens classification of fracture neck of femur, indication/type of surgery, packed cell volume (PCV), anaesthesia type, estimated blood loss, transfusions, duration of surgery and hospital stay, post-operative PCV, pain management, complications and surgical outcome. Results were summarised as means, median and percentages using SPSS version 21.0 for Windows®. One-way test of ANOVA was used for statistical significance (p= 0.05). Seventeen patients aged 27-90 years (mean 54.71±19.69). Indications were femoral neck fracture (47%), chronic osteoarthritis (35%), avascular necrosis (18%). The commonest procedure was hemiarthroplasty (41%), total hip replacement (35%), and total knee (24%). All were under regional anaesthesia with spinal (53%) and combined spinal-epidural (47%). Multimodal post-operative analgesia was used. There was no significant difference between pre and post-operative PCV (t = 0.708, p=0.05). Mean duration of hospital stay was 19.44±9.61 days. The outcome was good in all. JRT can be established in a new center with proper planning. Regional anaesthesia with multimodal analgesia is recommended. With relevant surgical skill, patient outcome is good.