Patients with moderate to severe osteoarthritis of the knee underwent primary elective knee arthroplasty in a well-equipped hospital in Accra, Ghana. Our main outcome measures was the new modified Oxford Knee scores (preoperative and postoperative scores). Median preoperative and postoperative knee scores were 10 and 42.5, respectively, at last follow-up with a P value<0.05 showing the reliability and significance of the scores. The average duration of inpatient hospital stay was 10 days. Of the seven patients who had surgery, one patient developed a chest infection postoperatively and another had failure of bone graft and required a revision. There was no postoperative wound infection or joint instability. The clinical outcome for this series of patients among other factors has been good within the prevailing circumstances and this shows that knee arthroplasty in developing Africa is a reality in the horizon.

Many studies in the literature have been carried out to evaluate the various cellular and molecular processes involved in osteogenesis. Angiogenesis and bone formation work closely together in this group of disorders. Hypoxia-inducible factor (HIF) which is stimulated in tissue hypoxia triggers a cascade of molecular processes that helps manage this physiological deficiency. However, there still remains a paucity of knowledge with regard to how sickle cell bone pathology, in particular avascular necrosis, could be altered when it comes to osseointegration at the molecular level. Hypoxia-inducible factor has been identified as key in mediating how cells adapt to molecular oxygen levels. The aim of this review is to further elucidate the physiology of hypoxia-inducible factor with its various pathways and to establish what role this factor could play in altering the disease pathophysiology of avascular necrosis caused by sickle cell disease and in improving osseointegration. This review article also seeks to propose certain research methodology frameworks in exploring how osseointegration could be improved in sickle cell disease patients with total hip replacements and how it could eventually reduce their already increased risk of undergoing revision surgery.Cite this article: EFORT Open Rev 2019;4:567-575. DOI: 10.1302/2058-5241.4.180030

Introduction With the continued and effective transfer of orthopaedic knowledge and skills across continents, the incidence of hip and knee replacement surgery has increased in the developing world. More patients are having these procedures done locally rather than having to travel over to the more developed western countries at great financial costs for those who cannot really afford it. We report the data collected by an orthopaedic charity MOTEC LIFE UK which has been offering hip and knee arthroplasty procedures to patients who require them. The time period of the procedures was February 2013–October 2017. Methods The data was collated prospectively and this included age, sex, indication for procedure, and side of procedure (including if bilateral). The information on hip implants used were also collected—implant type (cemented or uncemented), type of bearing surface, size of acetabular cup, liner, femoral head size, and stem size and including if screws were used to augment the fixation of the femoral cup. For the knee implants used, information on the type of implant (semi-constrained, cruciate retaining, or Stanmore hinge knee prosthesis), femoral and tibia stem size, insert type (fixed bearing or mobile bearing), and size; patella button size (whether patella replacement or circumcision) were collected. The surgical approach used in both knee and hip arthroplasty cases was noted. Results It is seen from the data collected that a total of 113 hip arthroplasty procedures from 109 patients were carried out and for total knee replacements, 82 knee arthroplasty procedures from 76 patients were carried out. The above procedures were carried out in two separate hospitals. Degenerative osteoarthritis still remains the main indication for hip and knee arthroplasty surgery in our study and this is similar to other joint registries around the world. It was noted that the incidence of avascular necrosis as an indication hip surgery was higher than that seen in registries for developed countries. The mean age for the hip and knee replacement patient in our data was much lower than that what is obtained in the developed world. Furthermore, it was observed that there was increased use of semi-constrained knee prosthesis due to the severe osteoarthritic deformities noted in the patients seen when compared to rate of use of similar implants in the developed world. Conclusion This observational study could serve as a springboard for establishment of arthroplasty registries for countries in the sub-region as a whole.

IntroductionWe report a rare case of an infected revision total knee replacement as a result of a Lactobacillus species infection. Lactobacillus infections have been associated with prolonged broad-spectrum antibiotic use. This can have implications in revision surgery, especially when patients have been on previous long-term suppressive antibiotic therapy.Case presentationAn 81-year-old British man with a previous history of complex revision knee arthroplasty for infection presented with a hot, swollen knee joint. He had previously been on long-term suppressive antibiotic therapy. Aspiration of the knee joint yielded a culture of Lactobacillus species.ConclusionIn patients undergoing revision joint arthroplasty, especially for previous infection, the presence of common and uncommon bacterial species must be excluded and eradicated before further surgical intervention.

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