Total joint replacement in sub-Saharan Africa: a systematic review

Davies, Peter; Graham, Simon Matthew; Maqungo, Sithombo; Harrison, William J.

doi:10.1177/0049475518822239

Cited by 18 publications

(7 citation statements)

References 20 publications

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“…The median length of stay observed in this study was longer compared to literature from the developed world 26 but consistent with data from the developing world 22,24,27 . A possible explanation based on our experience could be due to little emphasis on cost effective care and resources miss match resulting in prolonged hospital stay and delay in accessing supporting services such as radiology, physiotherapy and laboratory.…”

Section: Discussionsupporting

confidence: 89%

“…In regards to arthroplasty, the median age and gender ratios are comparable to that recorded in other studies 22,23 but differs slightly from finding from a study from Malawi and Ghana 24,25 . The study however, points to an increased importance of fragility fractures or neck of femur fracture in total hip arthroplasty and posttraumatic arthritis in both total hip and knee arthroplasty.…”

Section: Discussionsupporting

confidence: 63%

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Epidemiology and medical costs of orthopedic conditions in a tertiary hospital in Kenya; A five-year analysis of admission data

Kihuba

2022

Preprint

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Background: Orthopedic services are a key component of the surgical healthcare system. Scaling up these services would not only reduce the musculoskeletal diseases burden but also the overall disease burden significantly. As such quality intelligence on epidemiology and costs of orthopedic services should be accurately represented for guiding effective policy formulation and implementation. Aim: The aim of the study was to provide a snapshot of the pattern of orthopedic admissions, care and associated medical costs in Kenya. Methods: A retrospective study was conducted reviewing case files of patients admitted to the orthopedic department from 1st January 2015 to 30st November 2019. Results: There were 4320 distinct musculoskeletal admission diagnoses among the 3527 admissions. The study shows that trauma accounts for 53.04% of all admissions while joint replacement, shoulder and knee, limb deformities, infection, removal of hardware, ankle and foot and tumour procedures accounts for 15.01%, 8.87%, 7.29%, 6.44%, 3.94% and 3.23% respectively. Joint replacement is the leading diagnosis among patients in the 61 to 75 years age group and fragility fractures and posttraumatic arthritis featured prominently as the key reasons for joint reconstruction. The proportion of admissions with health insurance (60.82%) was exceptionally high compared to the national average (19.59%). However, current financing mechanism provide inadequate social protection against cost of orthopaedic surgery. Conclusion: The case volume and mix highlight the growing importance of trauma, fragility fractures and degenerative joint diseases in orthopaedic care in developing country set up. Overall, the observed model of care and associated outcome and costs provide a blueprint for orthopaedic system development.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 63%

Epidemiology and medical costs of orthopedic conditions in a tertiary hospital in Kenya; A five-year analysis of admission data

Kihuba

2022

Preprint

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“…Contrary to ERP goals of same day (as operation) mobilisation [26], only 38.1% of our study cohort mobilised out of bed on the first postoperative day while 14.4% of patients were unable to complete the TUG test on the third postoperative day. Inability to perform timely joint replacement is associated with musculoskeletal decompensation and delayed rehabilitation in LMICs [27]. Lack of standardised postoperative multimodal pain management, as was the case in our study, possibly further contributed to delayed mobilisation [26].…”

Section: The Quality Postoperative Recovery For Tha and Tka Patientsmentioning

confidence: 70%

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Plenge

Parker

Davids

et al. 2020

BMC Musculoskelet Disord

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Background Encouraged by the widespread adoption of enhanced recovery protocols (ERPs) for elective total hip and knee arthroplasty (THA/TKA) in high-income countries, our nationwide multidisciplinary research group first performed a Delphi study to establish the framework for a unified ERP for THA/TKA in South Africa. The objectives of this second phase of changing practice were to document quality of patient recovery, record patient characteristics and audit standard perioperative practice. Methods From May to December 2018, nine South African public hospitals conducted a 10-week prospective observational study of patients undergoing THA/TKA. The primary outcome was ‘days alive and at home up to 30 days after surgery’ (DAH30) as a patient-centred measure of quality of recovery incorporating early death, hospital length of stay (LOS), discharge destination and readmission during the first 30 days after surgery. Preoperative patient characteristics and perioperative care were documented to audit practice. Results Twenty-one (10.1%) out of 207 enrolled patients had their surgery cancelled or postponed resulting in 186 study patients. No fatalities were recorded, median LOS was 4 (inter-quartile-range (IQR), 3–5) days and 30-day readmission rate was 3.8%, leading to a median DAH30 of 26 (25–27) days. Forty patients (21.5%) had pre-existing anaemia and 24 (12.9%) were morbidly obese. In the preoperative period, standard care involved assessment in an optimisation clinic, multidisciplinary education and full-body antiseptic wash for 67 (36.2%), 74 (40.0%) and 55 (30.1%) patients, respectively. On the first postoperative day, out-of-bed mobilisation was achieved by 69 (38.1%) patients while multimodal analgesic regimens (paracetamol and Non-Steroid-Anti-Inflammatory-Drugs) were administered to 29 patients (16.0%). Conclusion Quality of recovery measured by a median DAH30 of 26 days justifies performance of THA/TKA in South African public hospitals. That said, perioperative practice, including optimisation of modifiable risk factors, lacked standardisation suggesting that quality of patient care and postoperative recovery may improve with implementation of ERP principles. Notwithstanding the limited resources available, we anticipate that a change of practice for THA/TKA is feasible if ‘buy-in’ from the involved multidisciplinary units is obtained in the next phase of our nationwide ERP initiative. Trial registration The study was registered with ClinicalTrials.gov (NCT03540667).

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“…1 The success of THA is well documented, with high patient satisfaction rates, low morbidity rates and cost-effective surgery. 2 Most of these publications come from THA performed in high-volume arthroplasty units, done in high-income countries. Limited data is available on THA performed in low-volume, low-income countries.…”

Section: Introductionmentioning

confidence: 99%

The accuracy of pre-operative digital templating in total hip arthroplasty performed in a low-volume, resource-constrained orthopaedic unit

et al. 2020

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Aims: Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in modern medicine. The success of THA is well documented, and includes high patient satisfaction rates, low morbidity rates and cost-effective surgery. Most publications come from THA performed in high-volume arthroplasty units, done in high-income countries. Limited data is available on THA performed in low-volume, low-income countries. The aim of this study was to evaluate the accuracy of digital templating in a low-volume, resource-constrained orthopaedic unit from 2016 to 2017. We introduced a standardised hip radiography programme, followed by a stepwise pre-operative templating method. We compared the implant sizes inserted during THA with the templated sizes determined pre-operatively. This was to deduct whether digital templating in a low-volume arthroplasty unit is accurate and of the same value as digital templating done in a high-volume unit. Methods: A descriptive retrospective study was conducted on all patients who received elective primary uncemented THA in a low-volume, resource-constrained orthopaedic unit. Pre-operative radiographs were done according to guidelines published by Scheerlinck followed by pre-operative templating using the Impax Orthopaedic tools® software and a stepwise technique described by Bono. Implanted prosthesis sizes, as recorded in operation notes, were retrospectively compared to pre-operative templating. Results: A total of 56 participants were included (30 females, 26 males), with a mean age of 55.5 (32-78) years. On the acetabular side, in 71% (n=40; p<0.001) there was a cumulative difference of one implant size between the templated cup size and the actual cup size used. On the femoral side, in 79% (n=44; p<0.001) there was a cumulative difference of one implant size between the templated stem size and the actual stem size used. Oversizing of the implants was more prevalent, with 20% (n=11) of the acetabular components oversized by two or more sizes and 13% (n=7) of the femoral components oversized by two or more sizes. Conclusion: With the introduction of a standardised radiology programme and a stepwise templating technique, the benefits and accuracy of pre-operative templating done in a low-volume, resource-constrained orthopaedic unit is comparable to published data done in high-volume arthroplasty units.

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Total joint replacement in sub-Saharan Africa: a systematic review

Cited by 18 publications

References 20 publications

Epidemiology and medical costs of orthopedic conditions in a tertiary hospital in Kenya; A five-year analysis of admission data

Epidemiology and medical costs of orthopedic conditions in a tertiary hospital in Kenya; A five-year analysis of admission data

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

The accuracy of pre-operative digital templating in total hip arthroplasty performed in a low-volume, resource-constrained orthopaedic unit

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