Total Hip Arthroplasty in a Low-Income Country

Abstract

Background: We describe our 10-year experience performing total hip arthroplasty (THA) in patients enrolled in the National Joint Registry of the Malawi Orthopaedic Association. Methods: Eighty-three THAs were performed in 70 patients (40 male and 30 female) with a mean age of 52 years (range, 18 to 77 years). The cohort included 24 patients (14 male and 10 female; mean age, 52 years [range, 35 to 78 years]) who were human immunodeficiency virus (HIV)-positive. Results: The main indications for surgery were osteonecrosis (n = 41 hips) and osteoarthritis (n = 26 hips). There were no deaths perioperatively and no early complications at 6 weeks. Forty-six patients (59 THAs) were seen at 10 years postoperatively, with a mean Harris hip score (HHS) of 88 (range, 41 to 91) and a mean Oxford Hip Score (OHS) of 46 (range, 25 to 48). Five hips (8% of 59) were revised due to loosening (n = 4) and fracture (n = 1). There were no infections or dislocations. Fourteen patients died, including 4 HIV-positive patients, of unknown causes in the follow-up period, and 10 patients were lost to follow-up. In the group of 24 HIV-positive patients, there were no early complications, and the mean HHS was 88 (range, 76 to 91) at >10 years. Conclusions: Our 10-year experience and long-term outcomes after primary THA in a low-income setting show that good results can be achieved within a controlled hospital environment, thereby establishing a benchmark against which other hospitals and registries in similar low-income countries can compare their results. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Impact of Human Immunodeficiency Virus on Postoperative Outcomes following Osteonecrosis-Indicated Total Hip Arthroplasty

“…Additionally, postoperative outcomes were defined by surgical revision rates and were assessed at 2 years post-THA. This timeframe may not be long enough for statistically significant revision rates to appear in the cohorts, so future studies may consider extending their definition of long-term outcomes to 5 or 10 years as was done in Graham et al 31…”

Total Joint Arthroplasty in HIV-Positive Patients in Malawi

“…Ethical approval has been given to the NARMOA from the Research Ethics Committee of the College of Medicine of the University of Malawi since its inception in 2005. Previous studies by our group using data from the NARMOA of all patients with known HIV status have shown low complication rates and good functional outcomes 9,[25][26][27] .…”

“…However, these studies have included HIV-positive patients with hemophilia and/or a history of intravenous drug use, which are independent risk factors for joint infection 16,24 . Our previous studies 9,[25][26][27] have demonstrated low complication rates in HIV-positive patients without hemophilia or intravenous drug-use history, and outcomes that are not substantially different than those of HIVnegative patients.…”

“…In the present study, we describe our medium-term findings on the prevalence of complications, including infection, and the functional outcomes of a group of HIV-positive patients, without hemophilia or a history of intravenous drug use, who underwent TJA in a low-income country. These data include patients from 4 of our previous studies 9,25-27 in which we reviewed complication rates and functional outcomes following TJA. While we have previously reported on HIV-positive TJA patients in the NARMOA, the current report contains additional patients who more recently have undergone surgery, giving a larger cohort, and providing longer follow-up than previously reported.…”

Total hip arthroplasty in Cambodia – Our experience of two hundred and fifty six consecutive total hip arthroplasties in a low-income country & the challenge of service delivery in this setting

“…4 Various different platforms have been trialed in order to deliver arthoplasty in low-income countries including government sponsored programs, charitable missions with visiting surgeons and development of specialist hospitals either through charitable donations, government funding or a mixture of both. 5–7 Revision arthroplasty has an increased cost in terms of implants but also increased morbidity to the patients both acutely and in long term functional outcome. In developed healthcare systems the safety and long term outcomes of arthroplasty have been improved through evidence based implant selection, 1,8 stringent infection control measures, advanced recovery protocols and dedicated arthroplasty follow up clinics to identify problems early.…”