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Barro V, Carbonell-Rosell C, Ribera J, Villalonga A, Martin-Domínguez L, Soza D, Plomer M, Aguilar M, Sevil R, José Echarri J. Challenges in implementing a total hip arthroplasty program in a developing country: Our experience at Monkole Hospital in the Democratic Republic of Congo. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00133-4. [PMID: 39069070 DOI: 10.1016/j.recot.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 07/12/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Total hip arthroplasty (THA) is an effective surgery for treating hip osteoarthritis, but access is limited in Sub-Saharan Africa due to multiple challenges. This article describes the implementation of a THA program at Monkole Hospital in the Democratic Republic of Congo, focusing on the technical challenges and surgical complications. The objective is to share our experience to assist other professionals and organizations in similar settings. MATERIALS AND METHODS Eight THA surgery campaigns were conducted between July 2019 and February 2023. Most patients presented with femoral head necrosis secondary to sickle cell anemia. Demographic and surgical data, technical difficulties, and complications were prospectively collected, and follow-up was conducted by a local orthopedic surgeon. RESULTS Seventy-three surgeries were performed on 63 patients with a mean age of 34 years and an average follow-up of 24 months. Seventeen intraoperative technical incidents (23.2%) were observed. The postoperative complication rate was 9.5%, and three patients required revision surgery due to complications. CONCLUSIONS The THA program at Monkole Hospital demonstrates that it is feasible to perform complex surgeries in developing countries and that it is a cost-effective procedure that improves patients' quality of life, provided there are adequate hospital infrastructures, team training, availability of implants, and ensured proper care and follow-up. Training local surgeons and investing in resources are key to the sustainability of the program and the improvement of surgical care.
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Affiliation(s)
- V Barro
- Hospital Universitari Vall d'Hebron, Barcelona, España
| | | | | | | | | | - D Soza
- Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Plomer
- Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Aguilar
- Hospital Universitari Vall d'Hebron, Barcelona, España
| | - R Sevil
- Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J José Echarri
- Centre Hospitalier Monkole, Kinshasa, República Democrática del Congo
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Hasan AI, Wajahath M, Nasser E, Nasser M, Saleh KJ. Transforming Global Orthopaedic Missions Through Adversity, Lessons Learned, and Sustainable Planning Using Quality Assurance Principles: The FAJR Methodology. J Bone Joint Surg Am 2024; 106:1338-1349. [PMID: 38723017 DOI: 10.2106/jbjs.23.01272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Affiliation(s)
- Ahmad I Hasan
- FAJR Scientific, Ann Arbor, Michigan
- Department of Orthopedic Surgery, Detroit Medical Center, Detroit, Michigan
| | - Muaaz Wajahath
- FAJR Scientific, Ann Arbor, Michigan
- Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Elias Nasser
- FAJR Scientific, Ann Arbor, Michigan
- University of Texas Southwestern Medical School, Dallas, Texas
| | | | - Khaled J Saleh
- FAJR Scientific, Ann Arbor, Michigan
- Michigan State University College of Human Medicine, East Lansing, Michigan
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Vaishya R, Gupta BM, Kappi MM, Mamdapur GMN, Vaish A. Global research output and highly-cited publications on prosthetic joint infections: A bibliometric analysis (2003-2022). J Clin Orthop Trauma 2024; 50:102373. [PMID: 38450413 PMCID: PMC10914558 DOI: 10.1016/j.jcot.2024.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/03/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
Backgroundand aims Prosthetic Joint Infection (PJI) is a serious clinical problem after Arthroplasty. The research field on PJI is emerging, but there is a paucity of information on the most impactful publications on it. This prompted us to conduct a bibliometric analysis of the global research output, from 2003 to 2022, to identify the growth of publications, the key players in this research field and to evaluate the characteristics of highly-cited publications (HCPs) on the PJI. Methods Publications related to PJI research were identified globally from the Scopus database, using specific keywords, covering the literature from 2003 to 2022. The HCPs were considered those with 100 or more citations. Information on publication year, citation count, funding sources, title, author, journal, country, institution, research area, and strategic keywords were collected from these HCPs. Publication data was imported into Microsoft Excel and analyzed further using VOSviewer and R software. Results There were 182 HCPs (3.12%), which received a total citation of 124701 (average CPP of 21.41), with the citation range from 100 to 1921. Research articles were the most predominant publications (69.2%), but their average citations per paper (CPP) of 189.78 was lower than that of Review articles (average CPP: 253.17). The USA has been the leading country in terms of total publications (31.58%), and HCPs (36.99%), followed by Switzerland, Spain, UK and China. There were no HCPs from developing countries. J. Parvizi of Thomas Jefferson University, USA (with a total publications of 31 and an average CPP of 315.7), and W. Zimmerli of Basel University, Switzerland (with a TP of 11 and an average CPP of 341.9), were the most productive and impactful authors in PJI global research output. Conclusion This bibliometric analysis identified the most productive and impactful authors, organizations, countries, and journals in the research of PJI, of the last two decades.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
| | | | - Mallikarjun M. Kappi
- Library and Information Centre, Government First Grade College, Hosapete, 583201, Vijayanagara (Dist), Karnataka, India
| | - Ghouse Modin Nabeesab Mamdapur
- Department of Library and Information Science, Yenepoya (Deemed to be University), Deralakatte, Mangalore, 575018, Karnataka, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
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Chaudhry YP, Mekkawy KL, Wenzel A, Campbell C, Sterling RS, Khanuja HS. Comparing Pain and Pain Coping Mechanisms in Patients Undergoing Total Joint Arthroplasty as Part of a Mission Trip to Those in the United States. J Arthroplasty 2023; 38:1700-1704.e6. [PMID: 37054927 DOI: 10.1016/j.arth.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Access to total joint arthroplasty can be difficult in low-resource settings. Service trips are conducted to provide arthroplasty care to populations in need around the world. This study aimed to compare the pain, function, surgical expectations, and coping mechanisms of patients from one such service trip to the United States. METHODS In 2019, the Operation Walk program conducted a service trip in Guyana during which 50 patients had hip or knee arthroplasties. Patient demographics, patient-reported outcome measures, questionnaires assessing pain attitudes and coping, and pain visual analog scales were collected preoperatively and at 3 months postoperatively. These outcomes were compared with a matched cohort of elective total joint arthroplasty at a US tertiary care medical center. There were 37 patients matched between the 2 cohorts. RESULTS The mission cohort had significantly lower preoperative self-reported function scores than the US cohort (38.3 versus 47.5, P = .003), as well as a significantly larger improvement at 3 months (42.4 versus 26.4, P = .014). The mission cohort had significantly higher initial pain (8.0 versus 7.0, P = .015), but there were no differences with regard to pain at 3 months (P = .420) or change in pain (P = .175). The mission cohort had significantly greater preoperative scores in pain attitude and coping responses. CONCLUSION Patients in low-resource settings were more likely to have preoperative functional limitations and pain, and they coped with pain through prayer. Understanding the key differences between these 2 types of populations and how they approach pain and functional limitations may help improve care for each group. LEVEL OF EVIDENCE II, prospective study.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Kevin L Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alyssa Wenzel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Claudia Campbell
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Alqatub A, Hasan GA, Wahab MS, Katran MH, Wais YB, Masaoodi AF, Shetty GM. Primary constrained condylar knee arthroplasty in severe varus deformity: a prospective 5-year functional follow-up study in Iraqi patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:459-463. [PMID: 36592240 DOI: 10.1007/s00590-022-03470-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/20/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The outcomes of the constrained condylar knee (CCK) implant used during primary total knee arthroplasty (TKA) in knees with severe varus in patients from low- and middle-income countries (LMICs) such as Iraq are not known. Hence, this study aimed to analyze and report the functional outcome of CCK TKA in patients with severe varus deformities at the end of 5 years in Iraqi patients. METHODS In this prospective study, pre- and post-operative (at the end of 5 years) clinical outcome using Knee Society Score (KSS) and radiological deformity using hip-knee-ankle (HKA) angle was analyzed in 76 CCK TKAs (20 bilateral and 36 unilateral TKAs) performed in 56 patients with severe varus deformity (> 15°). RESULTS At a mean follow-up of 60.3 months (range 60-68 months), the mean preoperative KSS knee score of 6.6 ± 4.5 improved significantly (p < 0.0001) to 87.2 ± 6.6 and the mean preoperative KSS function score of 7.1 ± 6.4 improved significantly (p < 0.0001) to 70.4 ± 7.8. The function score was good to excellent in 64.3% (36 patients), fair in 28.5% (16 patients), and poor in 7.1% (4 patients) at the end of 5 years. The mean preoperative HKA angle significantly improved (p < 0.001) from 25.5° ± 6° varus (range 17°-37°) to 3° ± 2.5° varus (range 0°-7.5°) at final follow-up. CONCLUSION The CCK implant significantly improved pain and function in patients with severe varus deformity at the end of 5 years. The CCK implant is a good option during primary TKA in severe varus knees in patients from LMICs and can help achieve clinical outcomes similar to patients from high-income countries.
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Leifer VP, Katz JN, Losina E. The burden of OA-health services and economics. Osteoarthritis Cartilage 2022; 30:10-16. [PMID: 34023527 PMCID: PMC8605034 DOI: 10.1016/j.joca.2021.05.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a highly prevalent and disabling condition that affects over 7% of people globally (528 million people). Prevalence levels are even higher in countries with established market economies, which have older demographic profiles and a higher prevalence of obesity, such as the US (14%). As the 15th highest cause of years lived with disability (YLDs) worldwide, the burden OA poses to individuals is substantial, characterized by pain, activity limitations, and reduced quality of life. The economic impact of OA, which includes direct and indirect (time) costs, is also substantial, ranging from 1 to 2.5% of gross national product (GNP) in countries with established market economies. In regions around the world, the average annual cost of OA for an individual is estimated between $700-$15,600 (2019 USD). Though trends in OA prevalence vary by geography, the prevalence of OA is projected to rise in regions with established market economies such as North America and Europe, where populations are aging and the prevalence of obesity is rising.
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Affiliation(s)
- V P Leifer
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - J N Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - E Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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Shang J, Wang L, Gong J, Su D, Jia X, Wang Y. Impact of antibiotic prophylaxis courses on postoperative complications following total joint arthroplasty: Finding from Chinese population. J Clin Pharm Ther 2021; 47:61-69. [PMID: 34664290 DOI: 10.1111/jcpt.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Prolonged antibiotic prophylaxis after total joint arthroplasty (TJA) may not assist in minimizing postoperative complications, however, data based on the Chinese population have been limited. The purpose of this study is to investigate the effect of antibiotic prophylaxis on postoperative complications after TJA in Chinese patients. METHODS We retrospectively reviewed 990 patients undergoing elective primary TJA surgery from January 2016 to June 2019. Patients who received a short course (≤3 days) of antibiotic prophylaxis were compared with those who received a longer course (>3 days). Logistic regression analysis and subgroup analysis were performed to control for potential confounders. Beyond that, survival analysis was used to determine the cumulative incidence of postoperative complications. RESULTS AND DISCUSSION Follow-up to 12 months after surgery, the prevalence of system complications in the longer course group and the short course group were 5.1% and 3.9%, respectively (p = 0.451). Similarly, no statistical differences in incisional complications (1.5% vs. 1.8%, p > 0.999) and periprosthetic joint infection (PJI) (1.0% vs. 1.0%, p > 0.999) were observed between the two groups. After performing logistic regression analysis and survival analysis, no potential association was found between the course of antibiotic prophylaxis and postoperative complications. In addition, prolonged antibiotic prophylaxis conferred no benefit for high-risk obese patients. WHAT IS NEW AND CONCLUSION Extended antibiotic prophylaxis did not result in a statistically significant and clinically meaningful reduction in postoperative complications. Therefore, we recommended that the duration of antibiotic prophylaxis in TJA should be shortened to 3 days or less in the Chinese population.
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Affiliation(s)
- Jingjing Shang
- Department of Pharmacy, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Liangliang Wang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jinhong Gong
- Department of Pharmacy, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Dan Su
- Department of Pharmacy, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Xiaojun Jia
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yuji Wang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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Andenmatten K, Provence F, Cunningham M, Sepehri A, Perka C, Ylänkö P, Masri BA. Development and Implementation of International Curricula for Joint Replacement and Preservation. Orthop Clin North Am 2021; 52:27-39. [PMID: 33222982 DOI: 10.1016/j.ocl.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The number of patients undergoing joint replacement and preservation procedures continues to increase worldwide. Globally, there is no standardized educational pathway, training program, or recognized certification program for surgeons in these procedures. Development and implementation of new competency-based curricula to deliver specific educational events and resources may help trainees and practicing surgeons be able to perform these procedures more effectively and therefore improve patient outcomes in their respective countries. Ideally, a curriculum would be globally standardized and professionally designed to interactively meet the needs of surgeons. A competency-based approach with built-in assessment and evaluation processes is today's educational standard.
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Affiliation(s)
- Kokeb Andenmatten
- AO Foundation - AO Education Institute, Stettbachstrasse 6, Dübendorf 8600, Switzerland
| | | | - Michael Cunningham
- AO Foundation - AO Education Institute, Stettbachstrasse 6, Dübendorf 8600, Switzerland
| | - Aresh Sepehri
- Department of Orthopaedics, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Carsten Perka
- Charité, University Medicine Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Pipsa Ylänkö
- AO Recon, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Bassam A Masri
- Department of Orthopaedics, Complex Joint Reconstruction Clinic, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, 3rd Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
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