Establishing Arthroplasty Services in a Resource-Limited Setting: A Three-Year Nigerian Experience

Abstract

Background Total joint replacement (TJR) offers significant relief for patients with end-stage osteoarthritis and related joint disorders. However, access remains limited in many low-resource settings, including Nigeria. Despite the first hip replacement in Nigeria in 1974, arthroplasty services were scarce until the 2000s. UNIOSUN Teaching Hospital (UTH), Osogbo, established in 1998, lacked an arthroplasty unit until 2022. This study evaluates the early outcomes, challenges, and progress of establishing this subspecialty. Methods Prospective data were collected from February 2022 to January 2025 for patients undergoing total hip and knee replacements. Variables included demographics, diagnosis, joint affected, comorbidities, anesthesia, Oxford scores, and complications. Results A total of 135 procedures (81 hips, 54 knees) were performed on 108 patients. Surgical frequency increased from once every three weeks to 1–2 per week, accompanied by a gradual increase in the number of trained operating surgeons involved. The main indications were osteoarthritis, sickle cell disease, and trauma. Oxford scores improved from 10–20 preoperatively to >40 postoperatively. Two complications were recorded: one periprosthetic joint infection and one dislocation. Financial barriers prevented many eligible patients from receiving care. Conclusion This experience highlights the feasibility and impact of introducing arthroplasty in resource-constrained settings. With improved infrastructure and government support, such services can significantly enhance patient outcomes and address a growing public health need.