KNEE REPLACEMENT FOR THE ELDERLY
Her name is Josephine Fejokwu, a sixty year old widow from Delta State who resides in Lagos. History was made some years back in the Lagos State healthcare delivery system when she benefited from the first total knee replacement surgery done by a team of local surgeons at the Lagos State University Teaching Hospital, LASUTH, Ikeja. Consultant orthopaedic surgeon Dr. Ladipo Olawale led the team of surgeons from LASUTH and National Orthopaedic Hospital, Igbobi, in the operation that lasted for two and half hours. The sixty year old woman confided in Truhealth that her knee problem which medical experts called osteoarthritis of the knee started ten years ago.
Mrs Fejokwu explained how she became the first beneficiary of the free knee surgery. “I went for treatment at National Orthopaedic Hospital, Igbobi. I was told I needed to go for surgery for which I would pay about eight hundred thousand naira. At first I ran away. Later a doctor at Igbobi told me to go to Lagos State University Teaching Hospital. When I got there, the doctors examined me and asked me to report daily for treatment. One day, I was told there is a free surgery for knee problems. I could not believe it myself that the Lagos State would treat me free. It is unbelievable; so I thank God and I am very happy”. The Commissioner of Health, Dr. Jide Idris, said the surgery seeks to help elderly patients that cannot be accommodated in the major programme of limb deformity and corrective surgery started by the last administration. He said the state periodically sorts out cases who are adults with arthritis who require mobility aids but could not do operation .
He said “we decided to support the project when the recommendation was made for many reasons. We are equipping the facility in this teaching hospital which is supposed to provide specialized care for the patients. Secondly as a teaching hospital we are supposed to be training staff. So, this is another avenue to build capacity along other specialty. Thirdly, this is a crippling disease and some of the patients we have seen are very poor people who can also benefit from the free health programme. The Commissioner of Health further explained that this knee surgery was a pilot of programme which is a partnership between the state Ministry of Health and the company, Smith and Nephew who provided the instrumentation based on the fact that a number of implant of the knees were purchased from them.
Meanwhile, Dr. Ladipo Adewole who led the team of surgeons said the old lady was diagnosed for osteoarthritis which is a disease characterized by irreversible erosion of the cartilage which covers the ends of bones where they are approximated from joints. He added that the knee joint is formed where the lower end of the thigh bone (tibia) join. The knee cap (patella) is placed in front of this joint. Dr. Adewole explained that osteoarthritis is caused by localized pressure on the cartilage structure as a result of deformity or obesity, weakened cartilage structure due to rheumatic diseases and weakening of bone supporting the joint cartilage as is seen in sickle cell disease. He stated that the symptoms include pain, swelling, deformity and instability of the knee and the diagnosis is confirmed by x-rays.
In the past, medical experts treated osteoarthritis by administering pain relievers and anti-inflammatory drugs as well as physiotherapy, weight control, and waking aids. Results from this kind of treatment were largely unsatisfactory because of persistent pain and difficulty due to decreased mobility. By this bold step, Lagos state is poised to retain its place as the premier state in the provision of healthcare in Nigeria.
The prototype of the instrumentation for total knee replacement as it is known today was designed by an English man living in New York as far back as 1972. Presently 150,000 total knee replacements are performed in the USA annually.