Patient-Reported Outcomes After Total Hip Arthroplasty in a Low-Resource Country by a Visiting Surgical Team

Abstract

Background: Total hip arthroplasty (THA) is a highly successful procedure but limited in many lowresource nations. In response, organizations globally have conducted service trips to provide arthroplasty care to underserved populations. Few outcomes data are currently available related to these trips. Our study aims to demonstrate the feasibility of tracking patient-reported outcomes and complications after THA in a low-resource setting and that outcomes are comparable to those in developed countries. Methods: We completed an arthroplasty service trip to Brazil in 2017 where we performed 46 THAs on 38 patients. The mean patient age was 48.8 years. Forty-seven percent were female. Patient-reported outcome scores were collected preoperatively and postoperatively at 2, 6, and 12 weeks and 1 year. A multivariate regression analysis was performed to identify associations between patient factors and 12week outcomes. Results: The mean modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, Patient-Reported Outcome Measurement Information System Short Form (PROMIS-SF) Pain Interference, and PROMIS-SF Physical Function all improved significantly compared to baseline at 2, 6, and 12 weeks and 1 year postoperatively. At 1 year, only 29% of patients (11 of 38) were reachable by phone for followup.Multivariate regression analysis at 12 weeks found that females had more improvement in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores (P ¼ .003) and PROMIS-SF Pain Interference scores (P ¼ .01) than males, and patients with rheumatoid arthritis had more improvement in PROMIS-SF Pain Interference scores (P ¼ .008) compared with all other diagnoses. Conclusion: Patients in low-resource countries benefitted significantly from THA performed by a visiting surgical team. However, following up patients is difficult in low-resource countries once they leave the hospital.

Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

“…The weighted follow-up rate was 57.5%. The majority reported in-person follow-up (83%) while three (16.7%) used technology-based platforms (SMS or phone calls) [27][28][29].…”

“…overwhelmed facilities [31] or a lack of a patient database [42]). However, the most commonly identified barrier was cost of follow-up to patients, both monetary and time costs, identified in six (22%) studies [25,26,28,[39][40][41]. Cost was primarily reported as it relates to financial assistance for patients (e.g.…”

“…PRO collection was reported in eleven (61%) studies; nine used PROs [17,27,29,[33][34][35][36], one collected PROs via semi-structured interviews [25], and one used a combination [26]. Of those using PROs, two did not specify any tool modifications [27,28], six specified using translated tools [9,13,15,16,37], and two included a translated and culturally adapted tool [29,34]. The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) were the only two instruments measuring patient-reported function and physical health utilized in more than one study.…”

“…Barriers to follow‐up were identified in fourteen (78%) studies and were found in each of the four levels of the socioecological framework (Fig. 3) [18, 21, 25–29, 31, 32, 34, 37–41]. The organization level had the greatest number of barriers (e.g.…”

Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis

“…41 Second, with the main outcome of PPSP occurrence as a categorical variable, it is also possible that we missed certain constructs of PPSP as captured by multidimensional or descriptive tools, such as PROMs 66 after hip and knee arthroplasty which has been well described elsewhere. 40 , 44 , 61 , 117 , 124 , 130 Third, this review included data both from studies on THR and TKR, although the literature has shown that pain and patient satisfaction outcomes from THR are generally better in comparison with TKR. 64 However, we analyzed the data separately, where possible.…”