Mulago offers free knee replacement for elderly

Ms Joyce Letiru, 59, from Arua City, has another chance to live a normal and productive life after a successful knee replacement surgery at Mulago National Referral Hospital relieved her from the joint disorder.  

Ms Letiru, a nurse by profession, is one of the 14 people who benefitted from the ongoing surgical camp where people with osteoarthritis, majorly the elderly, are getting specialised surgery. 

Osteoarthritis, according to orthopaedic surgeons at Mulago, occurs when the protective cartilage that cushions the ends of the bones wears down over time leaving patients with swelling and excruciating pain in the joints

The nurse told Daily Monitor yesterday at a ward in Mulago Hospital that her long service in a job that requires standing for long hours, age and weight could have caused arthritis.

“I started feeling this problem of the knees eight years ago. I was experiencing swelling in the knees and I had difficulties squatting. By then, when I tried to squat, I would hear noise inside my knees,” she narrated.

She said she got some medical care which didn’t help her much. The doctor, five years ago, advised her to go for a total knee replacement, but she couldn’t afford it because she needed to buy a knee implant at Shs9m. This amount is too high for a country with a per capita income of between $850 (Shs3.2m) and $1,045 (Shs3.9m).  “I told him [the doctor] that I don’t have money. So when I went back to work, I would always experience a lot of pain because of the nature of my work that requires standing for long hours,” Ms Letirua added.

But recently, Ms Letiru and other persons with osteoarthritis had a golden opportunity when some American partners led by Dr Jerry Cooper availed knee implants worth Shs1b.

Prevalence

According to orthopaedic experts, about 60 percent of the elderly in the country need the surgery that the wealthy Ugandans were earlier accessing in foreign countries.

“I took an X-ray and went back to them. And they assured me that they would consider me for total knee replacement. They screened us and put me on the list. It was not easy to decide again, I had some fear, but made up my mind knowing that the problem can make me limp,” Ms Letiru said. 

“I was admitted last Saturday and on Tuesday, they operated me. It was a very big experience which I had. I am walking as a form of exercise for a good recovery. I experienced pain yesterday, but today I am much better,” she added.

Dr Rosemary Byanyima, the acting executive director of Mulago Hospital, told the media yesterday that the surgical camp is being run by their doctors alongside the visiting experts from the US and Nairobi.

“We have advances [in services] at Mulago Hospital following the remodeling, rehabilitation and reequipping with high-tech equipment. They have been making these regular visits for skills transfer and our orthopaedic surgeons are doing many of these surgeries even as they continue to work with these teams,” she said.

Dr Byanyima said the visiting doctors came with some implants.

“The government through the National Medical Stores is unable to manage the cost of implants [because of the limited budget for health], but we hope that in future, especially if we get the National Health Insurance [Scheme] running, we shall be able to get these implants through the NMS,” she added.

Dr Norbert Orwotho, a consultant orthopaedic surgeon at Mulago Hospital, who also leads the surgical camp which started on Monday and is ending today, said they are running two activities.

“We are doing arthroplasty and arthroscopy. Arthroplasty means you are replacing someone’s knee with an artificial knee. Arthroscopy means you are using the camera to see inside someone’s knee and repairing what is damaged inside the knee,” he explained.

Dr Orwotho revealed that they started doing such surgeries in 2015, but they were disrupted in the last three years because of Covid-19 restrictions. He said they operate on around six patients every month and the only thing a patient needs to provide is the knee implants, which are imported from abroad, if there are no donations.

The consultant said when the joint is worn out, there is bone-to-bone contact, which is very painful and a person cannot walk.  Artificial joints are made from metallic surfaces with a special plastic in between and it is stuck inside the bone with bone cement. These expensive materials are not being made in Uganda because of the lack of technical capacity and tools to manufacture them.

“We import from companies in the US, Europe, South Africa and of late also India. On average, a patient spends around Shs10m to buy the materials and if you add the surgery and related services, you will spend somewhere between Shs20m and Shs30m,” he said.

A patient with both joints worn out can have one side worked on and the other side is handled after the healing of the other side. The average lifespan of an artificial joint is around 20 years. It takes a person around 1 month to recover after the surgery, according to Dr Orwotho. 

“About the cause of arthritis, some people have inborn problems which predispose them to the risk of experiencing early wear and tear. But the biggest problem is overweight and obesity,”  he  added.

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