Hip Replacement- The joy of walking again
Apr 12, 2009
LOOKING at 64-year old Canon Charles Tusiime, beaming from his hospital bed, you would not know he was groaning in pain and limped on crutches a few days ago.
By Josephine Maseruka
LOOKING at 64-year old Canon Charles Tusiime, beaming from his hospital bed, you would not know he was groaning in pain and limped on crutches a few days ago.
Tusiime, who runs a small restaurant in Kanungu, jumped off a pick-up 25 years ago. Although he never felt the pain immediately, later he could not move without crutches.
He has been limping with excruciating pain for 17 years. Like Tusiime, Consolanta Kantengwa of National Water and Sewerage Corporation, had developed degenerative arthritis (pain in the hip due to advanced age); a condition the two had lived with for decades.
Similarly, Salome Atiku, 40, a cook at University Hall, Makerere was involved in a motor accident in Bwaise in 1990. Her hip was dislocated, resulting in loss of blood supply to the head of the femur bone causing arthritis of the hip.
Atiku, a mother of two, had to abandon her job as she prayed for a Good Samaritan to meet her surgery costs. The trio’s agony would have persisted had it not been for the recent offer by International Hospital Kampala (IHK) to conduct total hip joint replacements at subsidized rates of $3,400 (about sh7.5m) per cementless implant.
The hospital brought in two orthopaedic surgeons, Tejas Thakker and Manjul Joshipura, from Apollo Hospital, India. They were joined by a local medical team led by Dr. Patrick Ssekimpi, an orthopaedic surgeon at Mulago Hospital.
“Hip joint replacement has enabled thousands of people to have a complete and more active life. We replace a painful dysfunctional joint with a functional, long-lasting prosthesis,†explains Ssekimpi.
He adds that the cementless implants are better because they last more that 25 years without any side effect.
Conducting the operations in Uganda and subsidising, the cost reduced by 50% per operation from about sh15m to sh7.5m “We are happy to have been of help and to let Ugandans know that hip implants can successfully be conducted here,†Dr. Ian Clarke, the proprieter of IHK says. Dr. Hamza Nseera, a medical officer at the hospital, says Katengwa’s case is hereditary and had worsened with old age causing a defective hip bone.
The operation will help to re-establish function of the hip and enable her perform most functions like walking and sitting in two months. The three admit that already there is a great change in their lives.
Information from the American Academy of Orthopaedic Surgeons shows that implants are made from metal alloys, high–grade plastics and polymeric materials.
Hip replacement is in four types: cementless, cemented, hybrid — which is a combination of the first two, and partial, where part of the joint is damaged and diseased.
Each type comes in different sizes to accommodate the various body shapes. In some designs, the stem and ball are one piece; other designs are modular, allowing for additional customization in fit. Implant insertion involves making the incision between the large hip muscles to gain access to the joint cavity to remove the affected parts and to insert the implant.
Cemented implants date 40 years back and are made from acrylic polymer. A patient can put full weight on the limb and walk without support immediately after the surgery resulting in faster rehabilitation.
This method is most recommended for older patients, those with rheumatoid arthritis and for young patients with compromised health or poor bone quality and density.
Such patients are less likely to put stress on the cement that could lead to fatigue fractures. Cementless total hip replacement dates back in the 1980s. The implants are attached directly to the bone.
The designs are larger and longer than those used with cement. They have a surface coating to allow new bone growth into the surface of the implant. They take longer to heal than cemented ones.
They are recommended for younger, more active patients and those with good bone quality where bone growth into the components can be predictably achieved.
The stems can loosen if a strong bond between the bone and the stem is not achieved. Patients with large cementless stems may also experience a higher incidence of mild thigh pain.
Atiku appeals to the Government to subsidise the costs of operation. “The pain from the cut is nothing compared to the hell I have been through,†Katengwa says.
Clarke and Ssekimpi say hip replacement is not new in Uganda although it was the first time IHK subsidised the cost. Ssekimpi says many Ugandans who need the operation but because of the cost, even Mulago Hospital cannot do much.
He could not give the figures though. Clarke says the same operation in India costs $9,000 (about sh19.6m), in South Africa, $20,000 (about sh43m) and it is even higher in Europe.
LOOKING at 64-year old Canon Charles Tusiime, beaming from his hospital bed, you would not know he was groaning in pain and limped on crutches a few days ago.
Tusiime, who runs a small restaurant in Kanungu, jumped off a pick-up 25 years ago. Although he never felt the pain immediately, later he could not move without crutches.
He has been limping with excruciating pain for 17 years. Like Tusiime, Consolanta Kantengwa of National Water and Sewerage Corporation, had developed degenerative arthritis (pain in the hip due to advanced age); a condition the two had lived with for decades.
Similarly, Salome Atiku, 40, a cook at University Hall, Makerere was involved in a motor accident in Bwaise in 1990. Her hip was dislocated, resulting in loss of blood supply to the head of the femur bone causing arthritis of the hip.
Atiku, a mother of two, had to abandon her job as she prayed for a Good Samaritan to meet her surgery costs. The trio’s agony would have persisted had it not been for the recent offer by International Hospital Kampala (IHK) to conduct total hip joint replacements at subsidized rates of $3,400 (about sh7.5m) per cementless implant.
The hospital brought in two orthopaedic surgeons, Tejas Thakker and Manjul Joshipura, from Apollo Hospital, India. They were joined by a local medical team led by Dr. Patrick Ssekimpi, an orthopaedic surgeon at Mulago Hospital.
“Hip joint replacement has enabled thousands of people to have a complete and more active life. We replace a painful dysfunctional joint with a functional, long-lasting prosthesis,†explains Ssekimpi.
He adds that the cementless implants are better because they last more that 25 years without any side effect.
Conducting the operations in Uganda and subsidising, the cost reduced by 50% per operation from about sh15m to sh7.5m “We are happy to have been of help and to let Ugandans know that hip implants can successfully be conducted here,†Dr. Ian Clarke, the proprieter of IHK says. Dr. Hamza Nseera, a medical officer at the hospital, says Katengwa’s case is hereditary and had worsened with old age causing a defective hip bone.
The operation will help to re-establish function of the hip and enable her perform most functions like walking and sitting in two months. The three admit that already there is a great change in their lives.
Information from the American Academy of Orthopaedic Surgeons shows that implants are made from metal alloys, high–grade plastics and polymeric materials.
Hip replacement is in four types: cementless, cemented, hybrid — which is a combination of the first two, and partial, where part of the joint is damaged and diseased.
Each type comes in different sizes to accommodate the various body shapes. In some designs, the stem and ball are one piece; other designs are modular, allowing for additional customization in fit. Implant insertion involves making the incision between the large hip muscles to gain access to the joint cavity to remove the affected parts and to insert the implant.
Cemented implants date 40 years back and are made from acrylic polymer. A patient can put full weight on the limb and walk without support immediately after the surgery resulting in faster rehabilitation.
This method is most recommended for older patients, those with rheumatoid arthritis and for young patients with compromised health or poor bone quality and density.
Such patients are less likely to put stress on the cement that could lead to fatigue fractures. Cementless total hip replacement dates back in the 1980s. The implants are attached directly to the bone.
The designs are larger and longer than those used with cement. They have a surface coating to allow new bone growth into the surface of the implant. They take longer to heal than cemented ones.
They are recommended for younger, more active patients and those with good bone quality where bone growth into the components can be predictably achieved.
The stems can loosen if a strong bond between the bone and the stem is not achieved. Patients with large cementless stems may also experience a higher incidence of mild thigh pain.
Atiku appeals to the Government to subsidise the costs of operation. “The pain from the cut is nothing compared to the hell I have been through,†Katengwa says.
Clarke and Ssekimpi say hip replacement is not new in Uganda although it was the first time IHK subsidised the cost. Ssekimpi says many Ugandans who need the operation but because of the cost, even Mulago Hospital cannot do much.
He could not give the figures though. Clarke says the same operation in India costs $9,000 (about sh19.6m), in South Africa, $20,000 (about sh43m) and it is even higher in Europe.