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DeMaio EL, Marra G, Suleiman LI, Tjong VK. Global Health Inequities in Orthopaedic Care: Perspectives Beyond the US. Curr Rev Musculoskelet Med 2024; 17:439-448. [PMID: 39240419 PMCID: PMC11465105 DOI: 10.1007/s12178-024-09917-8] [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] [Accepted: 07/11/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE OF REVIEW The burden of musculoskeletal disease is increasing globally and disproportionately affecting people in low and middle income countries (LMIC). We sought to review global access to orthopaedic care, burden of trauma, research infrastructure, impact of surgical mission trips, implant availability, and the effect of COVID-19 upon the delivery of orthopaedic care worldwide. RECENT FINDINGS The majority of people in LMIC do not have access to safe, quality surgical care, and there are few fellowship-trained orthopaedic traumatologists. Road traffic accidents are the leading cause of long bone fractures in LMIC and result in significant morbidity and mortality. Of the orthopaedic literature published globally in the last 10 years, less than 15% had authors from LMIC. There has been growth in surgical mission trips to LMIC, but few organizations have established bidirectional partnerships. Among the challenges to delivering quality musculoskeletal care in LMIC is timely access to quality orthopaedic implants. Implant options in LMIC are more limited and subjected to less rigorous testing and regulation than high income countries (HIC). The COVID-19 pandemic dramatically reduced elective surgeries but saw the increase in telemedicine utilization which has prevailed in both HIC and LMIC. Awareness of global inequities in orthopaedic care is growing. Much can be learned through collaborations between orthopaedic surgeons from HIC and LMIC to advance patient care worldwide. There is a need for high quality, accurate data regarding incidence and prevalence of musculoskeletal disease, care utilization/availability, and postoperative outcomes so resources can be allotted to make orthopaedic care more equitable globally.
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Affiliation(s)
- Emily L DeMaio
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA.
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Iordache S, Cursaru A, Cretu B, Niculae CF, Popa M, Costache MA, Serban B, Cirstoiu C. Predictive Factors for Total Knee Arthroplasty: An Observational Study. Cureus 2024; 16:e67519. [PMID: 39310485 PMCID: PMC11416154 DOI: 10.7759/cureus.67519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Knee osteoarthritis (KOA) is the most common form of osteoarthritis. It is diagnosed based on clinical symptoms, physical examination, and imaging, most frequently by knee X-ray in at least two views. In front of a patient with early KOA, all the predictive factors and risk factors that can be modified, but also that can lead to a rapid evolution of the symptoms and the need for total knee arthroplasty (TKA), must be taken into account and identified. There were a series of prognostic factors associated with KOA, such as age, sex, BMI, degree of physical activity, decrease in bone mineral density, C-reactive protein, malalignment, clinical severity at baseline, and previous traumas. The treatment of KOA is varied and involves pharmacological and non-pharmacological measures and surgical treatment in the final stages of evolution. Materials and methods In the University Emergency Hospital of Bucharest, Bucharest, Romania, patients with KOA presented to the Department of Orthopedics and Traumatology, and those who required surgical treatment, such as TKA, arthroscopy, or non-surgical treatment, were enrolled. We conducted a descriptive and prospective observational study that included 70 patients clinically and imaging diagnosed with KOA. The inclusion criteria consisted of a patient over 45 years old with knee pain and radiological signs of KOA. The exclusion criteria referred to patients with recent traumatic history, signs of active osteoarticular infection, the lack of radiological changes of KOA that imposed the differential diagnosis, patients known to have rheumatological diseases in the Algic phase, and patients in whom it was not possible to collect complete required data. Results Patients who required TKA were older (65.12 ± 8.19 years) than patients who required other therapeutic interventions (52.55 ± 3.63 years), the difference of 12.57 years being statistically significant (t = -8.882, p ≤ 0.001). Women were more than three times more likely to require TKA than men (80.85% vs. 52.17%, OR = 3.87, CI [1.29, 11.56]). Patients with HBP were more than four times more likely to require TKA than patients without HBP (78.57% vs. 42.86%, OR = 4.88, CI [1.42, 16.82]). Patients with elevated ESR were more than 26 times more likely to require TKA than patients with normal ESR (96.67% vs. 52.50%, OR = 26.23, CI [3.25, 211.67]). There are statistically significant differences between the non-TKA group (mean rank = 60.20) and TKA patients' score (mean rank = 25.62) (U = 6.000, Z = -6.606, p ≤ 0.001). Thus, patients who required TKA had a significantly lower KSS score than patients who required other treatments. Conclusion According to the data obtained in the studied group of patients, the characteristics of the patient at high risk of requiring TKA are the following: a female patient over 65 years of age who associates hypertension, high ESR, and fibrinogen values with KSS score and KSS function with low values, recording an average value of 56.70.
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Affiliation(s)
- Sergiu Iordache
- Orthopaedics and Traumatology, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopaedics and Traumatology, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Bogdan Cretu
- Orthopaedics and Traumatology, Bucharest Emergency University Hospital, Bucharest, ROU
| | | | - Mihnea Popa
- Orthopaedics and Traumatology, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Mihai Aurel Costache
- Orthopaedics and Traumatology, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopaedics and Traumatology, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopaedics and Traumatology, Bucharest Emergency University Hospital, Bucharest, ROU
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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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Upshaw WC, Richey JM, Tassin JP, Frolov MV, Miller BC, Kaye AJ, Sterritt J, Fox CJ, Ahmadzadeh S, Shekoohi S, Kaye AD. IPACK Block Efficacy for Acute Pain Management after Total Knee Replacement: A Review. Curr Pain Headache Rep 2024; 28:673-679. [PMID: 38520494 DOI: 10.1007/s11916-024-01237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE OF REVIEW Patients often experience a significant degree of knee pain following total knee replacement (TKR). To alleviate this pain, nerve blocks may be performed such as the adductor canal block (ACB). However, ACBs are unable to relieve pain originating from the posterior region of the knee. A new type of nerve block known as the IPACK block may be used in conjunction with ACBs as it is designed to inhibit nerve branches innervating this area. In this article, we examine the rationale behind the IPACK procedure, how it is performed, and clinical trials examining its efficacy. RECENT FINDINGS 5 of the 7 clinical trials examined in this article showed the IPACK + ACB block to show superior efficacy in treating pain following TKR compared to other blocks. These blocks included PMDI+ACB, SPANK+ACB, PAI+ACB, ACB alone, and SCAB. 2 of the 7 clinical trials showed the IPACK + ACB to be less effective in managing patients pain following TKR compared to other blocks which included the CACB and 4 in 1 block. In most instances, the IPACK + ACB showed superior efficacy in managing patients' pain following TKR when compared to other types of nerve blocks. This was determined by measuring usage of opioids, reported postoperative pain, and length of hospital stays following TKR. Thus, we suppose the IPACK block may be used in conjunction with the ACB to effectively reduce patient's pain following TKR.
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Affiliation(s)
- William C Upshaw
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - John M Richey
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Joseph P Tassin
- School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, 70119, USA
| | - Mark V Frolov
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Benjamin C Miller
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Aaron J Kaye
- WakeMed Anesthesia, 3000 New Bern Ave, Raleigh, NC, 27610, USA
| | - Jeffrey Sterritt
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Charles J Fox
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Alan D Kaye
- Department of Anesthesiology, Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
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Yakkanti RR, Haziza S, Wasserman NA, Annapareddy A, Ratnakar V, Karri S, Hernandez VH, Gurava Reddy A, Vaishya R. Relative frequency of avascular necrosis of the hip as indication for primary Total Hip Arthroplasty in the USA vs. India. J Orthop 2023; 36:1-6. [PMID: 36531126 PMCID: PMC9747526 DOI: 10.1016/j.jor.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Background: Primary total hip arthroplasty (THA) is performed for a variety of pathologies. Osteoarthritis (OA) is the most common indication for THA in the United States of America (USA). The study aims to establish the incidence of indications for THA in the USA as compared to India and to assess whether Avascular Necrosis (AVN) of the Hip is a more frequent indication for THA in India than in the USA. Methods The National Inpatient Sample database (USA) and two Indian databases (one national and one regional) were analyzed to identify all patients who underwent primary THA within the databases. The relative frequencies of each indication for THA were determined. The patients' demographics and risk factors for AVN of the hip were recorded and assessed. The data were then compared across the patients in the USA and the patients in India. Results 225,061 primary THA patients were identified in the USA database and 20,288 in the Indian database. The proportion of primary THA performed for AVN in the American database (5.97%) was significantly lower than the proportion of THA performed for AVN in the Indian database (51.8%). Conclusion The relative frequency of AVN as an indication for THA is significantly higher in India than in the USA. It is important to recognize the differences in relative indications for THA between world populations, as outcomes after THA among Eastern populations of the world may not be equivalent to ones seen in their Western counterparts.
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Affiliation(s)
- Ramakanth R. Yakkanti
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Sagie Haziza
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, USA
| | - Nathan A. Wasserman
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Adarsh Annapareddy
- Sunshine Hospital, PG Road, Opposite Parsi Dharamsala, Paradise, Sappu Bagh Apaprtment, Jogani, Ramgopalpet, Secunderabad, Telangana, 500003, India
| | - V. Ratnakar
- Sunshine Hospital, PG Road, Opposite Parsi Dharamsala, Paradise, Sappu Bagh Apaprtment, Jogani, Ramgopalpet, Secunderabad, Telangana, 500003, India
| | - S.R. Karri
- Sunshine Hospital, PG Road, Opposite Parsi Dharamsala, Paradise, Sappu Bagh Apaprtment, Jogani, Ramgopalpet, Secunderabad, Telangana, 500003, India
| | - Victor H. Hernandez
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - A.V. Gurava Reddy
- Sunshine Hospital, PG Road, Opposite Parsi Dharamsala, Paradise, Sappu Bagh Apaprtment, Jogani, Ramgopalpet, Secunderabad, Telangana, 500003, India
| | - Raju Vaishya
- Indraprastha Apollo Hospital, Mathura Rd, New Delhi, Delhi, 110076, India
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Haziza S, Yakkanti RR, Wasserman NA, D'Apuzzo MR, Hernandez VH. Relative frequency of primary total hip arthroplasty for avascular necrosis in the United States as compared to a regional center: A data review. J Orthop 2022; 34:322-326. [PMID: 36204516 PMCID: PMC9531044 DOI: 10.1016/j.jor.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The relative frequencies of indications for primary total hip arthroplasty (THA) are not well-established. This study aims to establish the incidence of THA performed for Avascular Necrosis of the hip (AVN), as well as the other most common indications for THA in the United States, as compared to the incidences at a high-volume tertiary referral center in Miami, Florida. We hypothesize that the relative incidence of AVN and each other indication for THA will vary significantly between the United States as a whole and the tertiary referral center. Methods A query of the 2016-2017 National Inpatient Sample (NIS) and a tertiary referral center adult reconstruction registry was completed. The relative frequencies of each indication for THA, demographics, and behavioral risk factors were analyzed. Results 225,061 primary THA patients in the National Inpatient Sample database and 447 in the Miami tertiary referral center database were included in the final analysis. The proportion of primary THA for AVN in the NIS database (5.97%) was significantly lower than the same proportion in the tertiary referral center database (22.2%), p < .001. There was no significant difference in the incidence of primary THA for osteoarthritis, inflammatory arthritis, or hip dysplasia between the two populations. Conclusion The incidence of THA for AVN is significantly different between a tertiary referral center and the greater United States. Patient demographics, race, and behavioral risk factors are associated with the disparity. Orthopaedic surgeons should recognize the differences in THA indication between populations when counseling patients on treatments, outcomes, and the most current literature.
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Affiliation(s)
- Sagie Haziza
- University of Miami Hospital, Department of Orthopaedics, Miami, FL, USA
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Mannani M, Motififard M, Farajzadegan Z, Nemati A. Length of stay in patients undergoing total knee arthroplasty. J Orthop 2022; 32:121-124. [PMID: 35694328 PMCID: PMC9178328 DOI: 10.1016/j.jor.2022.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022] Open
Abstract
Background Minimizing costs associated with the care of patients undergoing total knee arthroplasty (TKA) can reduce the burden on health systems that regularly struggle with limited resources. Predicting and reducing TKA associated length of stay (LoS) can therefore be invaluable. This study aimed to determine the factors that impact LoS in patients undergoing TKA and propose a model design to predict LoS. Methods A retrospective study was performed on patients undergoing TKA in a tertiary teaching hospital. Patients who underwent TKA from March 2007 to March 2021 were included in the study. Data were extracted from available electronic and paper records. Variables evaluated included: patients' demographic data, general admission data, laboratory data, transfusion, operation data, and preoperative comorbidities and medical history. Independent T-test, one-way ANOVA, and Pearson correlation were used for univariate data analysis. For multivariate analysis and model designing, multiple regression stepwise methods were used. Results 878 patients were included in this study. Mean LoS was 6.09 (SD = 1.83) with a median of 6 days. Factors found to have a significant effect on length of stay were age, revision surgery, Anesthesia type, intensive care unit admission, insurance, transfusion, preoperative hemoglobin level, and pre-operative platelet (Plt) count. Applying a multiple regression stepwise model to these variables showed that the following pre-operative factors can be predictive for LoS: revision surgery, sex, medical insurance, hemoglobin level, and Plt count. Conclusions It was deduced that sex, revision, pre-operative hemoglobin and Plt level and health insurance were the best predictors for LoS in patients undergoing TKA.
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Affiliation(s)
- Mehran Mannani
- Medical Student, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Motififard
- Professor of Orthopedic Surgery, Orthopedics Department, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- Professor of Community Medicine, Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Nemati
- Orthopedic Surgeon, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Use of dual mobility cups for total hip arthroplasty in sub-Saharan Africa: interest and perspectives. INTERNATIONAL ORTHOPAEDICS 2021; 46:133-142. [PMID: 34414484 DOI: 10.1007/s00264-021-05184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hip arthroplasty and revision surgery are growing exponentially in OECD countries. In developing countries, it is an infrequent intervention and its practice is limited. It is exposed to a higher rate of infectious and mechanical failures than in developed countries. The aim of the actual study is to provide a review of the literature on total hip arthroplasty series in sub-Saharan Africa followed by an overview of the interest and perspectives of the use of dual mobility (DM) cups. MATERIALS AND METHODS Scopus, EMBASE, Medline, PubMed, and Safoonline databases were searched including papers published at any date. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. All papers from South Africa were excluded. RESULTS We identified 22 series of total hip arthroplasty in 14 SSA countries. The practice of total hip arthroplasty is not very widespread. The cups used are mostly conventional implants, and complications (mechanical and infectious) are frequent. DISCUSSION The interest for the use of dual mobility cups in sub-Saharan Africa can be summarized in two points: mechanical and socio-economical. Dual mobility cups provide more mechanical stability and a reduction in the overall cost of treatment by reducing the rate of complications. These prospects will make it possible to evaluate this medical device in the long term in a hostile environment conductive to complications. CONCLUSION The use of dual mobility deserves to be developed in African settings.
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Plenge U, Parker R, Davids S, Davies GL, Fullerton Z, Gray L, Groenewald P, Isaacs R, Kauta N, Louw FM, Mazibuko A, North DM, Nortje M, Nunes GM, Pebane N, Rajah C, Roos J, Ryan P, September WV, Shanahan H, Siebritz RE, Smit RW, Sombili S, Torborg A, van der Merwe JF, van der Westhuizen N, Biccard B. Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study. BMC Musculoskelet Disord 2020; 21:721. [PMID: 33153453 PMCID: PMC7643442 DOI: 10.1186/s12891-020-03752-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/28/2020] [Indexed: 12/26/2022] Open
Abstract
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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Affiliation(s)
- Ulla Plenge
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa.
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Shamiela Davids
- Department of Physiotherapy, Mitchell's Plain Hospital, AZ Berman Drive, Mitchell's Plain, Cape Town, Western Cape, 7785, South Africa
| | - Gareth L Davies
- Department of Anaesthesia, Paarl Hospital, Hospital Street, Paarl, Western Cape, 7646, South Africa
| | - Zahnne Fullerton
- Department of Anaesthesia, Victoria Hospital, Alphen Hill Rd, Wynberg, Cape Town, Western Cape, 7800, South Africa
| | - Lindsay Gray
- Department of Physiotherapy, New Somerset Hospital, Portswood Rd, Greenpoint, Cape Town, Western Cape, 8051, South Africa
| | - Penelope Groenewald
- Department of Physiotherapy, Universitas Academic Hospital, University of the Free State, Logeman Str, Bloemfontein, Free State, 9301, South Africa
| | - Refqah Isaacs
- Department of Physiotherapy, Victoria Hospital, Alphen Hill Rd, Wynberg, Cape Town, Western Cape, 7800, South Africa
| | - Ntambue Kauta
- Department of Orthopaedic Surgery, Mitchell's Plain Hospital, AZ Berman Drive, Mitchell's Plain, Cape Town, Western Cape, 7785, South Africa
| | - Frederik M Louw
- Department of Orthopaedic Surgery, New Somerset Hospital, Portswood Rd, Greenpoint, Cape Town, Western Cape, 8051, South Africa
| | - Andile Mazibuko
- Department of Anaesthesia, Steve Biko Academic Hospital, University of Pretoria, Corner Malan and Steve Biko Str, Capital Park, Pretoria, Gauteng, 0001, South Africa
| | - David M North
- Department of Orthopaedic Surgery, Paarl Hospital, Hospital Street, Paarl, Western Cape, 7646, South Africa
| | - Marc Nortje
- Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Glen M Nunes
- Department of Physiotherapy, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Vusi Mzimela Rd, Umkumbaan, Durban, KwaZulu-Natal, 4091, South Africa
| | - Neo Pebane
- Department of Physiotherapy, Steve Biko Academic Hospital, University of Pretoria, Corner Malan and Steve Biko Str, Capital Park, Pretoria, Gauteng, 0001, South Africa
| | - Chantal Rajah
- Department of Anaesthesia, Grey's Hospital, University of KwaZulu-Natal, Townbush Rd, Pietermaritzburg, KwaZulu-Natal, 3201, South Africa
| | - John Roos
- Department of Anaesthesia, Mitchell's Plain Hospital, AZ Berman Drive, Mitchell's Plain, Cape Town, Western Cape, 7785, South Africa
| | - Paul Ryan
- Department of Orthopaedic Surgery, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Vusi Mzimela Rd, Umkumbaan, Durban, KwaZulu-Natal, 4091, South Africa
| | - Winlecia V September
- Department of Physiotherapy, Paarl Hospital, Hospital Street, Paarl, Western Cape, 7646, South Africa
| | - Heidi Shanahan
- Department of Physiotherapy, Grey's Hospital, University of KwaZulu-Natal, Townbush Rd, Pietermaritzburg, KwaZulu-Natal, 3201, South Africa
| | - Ruth E Siebritz
- Department of Physiotherapy, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Rian W Smit
- Department of Orthopaedic Surgery, Grey's Hospital, University of KwaZulu-Natal, Townbush Rd, Pietermaritzburg, KwaZulu-Natal, 3201, South Africa
| | - Simon Sombili
- Department of Orthopaedic Surgery, Steve Biko Academic Hospital, University of Pretoria, Corner Malan and Steve Biko Str, Capital Park, Pretoria, Gauteng, 0001, South Africa
| | - Alexandra Torborg
- Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Vusi Mzimela Rd, Umkumbaan, Durban, KwaZulu-Natal, 4091, South Africa
| | - Johan F van der Merwe
- Department of Orthopaedic Surgery, Universitas Academic Hospital, University of the Free State, Logeman Str, Bloemfontein, Free State, 9301, South Africa
| | - Nico van der Westhuizen
- Department of Anaesthesia, Universitas Academic Hospital, University of the Free State, Logeman Str, Bloemfontein, Free State, 9301, South Africa
| | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Observatory, Cape Town, Western Cape, 7925, South Africa
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10
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Challenges to Implementing Total Joint Replacement Programs in Developing Countries. Orthop Clin North Am 2020; 51:131-139. [PMID: 32138851 DOI: 10.1016/j.ocl.2019.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this review article, the authors present the many challenges that orthopedic surgeons in developing countries face when implementing arthroplasty programs. The issues of cost, sterility, and patient demographics are specifically addressed. Despite the many challenges, developing countries are beginning to offer hip and knee reconstructive surgery to respond to the increasing demand for such elective operations as the prevalence of osteoarthritis continues to increase. The authors shed light on these nascent arthroplasty programs.
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11
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Maharaj Z, Pietrzak JRT, Sikhauli N, van de Jagt D, Mokete L. The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa. SICOT J 2020; 6:3. [PMID: 31967541 PMCID: PMC6975206 DOI: 10.1051/sicotj/2019042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/20/2019] [Indexed: 01/08/2023] Open
Abstract
Aim: The aim was to assess the seroprevalence of Human Immunodeficiency Virus (HIV) in non-haemophilic patients undergoing primary Total Joint Arthroplasty (TJA) at an academic hospital in South Africa. Methods: A retrospective review of all Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) patients from January 2017 to December 2018 was conducted. All patients awaiting TJA were offered HIV screening and their demographic data were recorded. Consenting patients were tested or the refusal of testing was documented. The CD4+ T-cell count (CD4+) and viral load (VL) was measured for all HIV-positive patients and newly diagnosed patients were initiated on Highly Active Antiretroviral Treatment (HAART). Results: We included 1007 patients in the study. The TJA population HIV seroprevalence was 10.7% (n = 108). The seroprevalence for THA was 14.9% (n = 78) and that for TKA was 6.2% (n = 30). There were 93 patients (9.2%) who refused screening. There were 12 (15.4%) and 3 patients (10%) that were newly diagnosed in the THA and TKA seropositive populations, respectively. The average CD4+ for THA and TKA was 569 cells/mm3 (105–1320) and 691 cells/mm3 (98–1406), respectively. The VL was undetectable in 75.9% (n = 82) of HIV-positive patients. Overall 12 HIV-positive patients (11.12%) had CD4+ <200 cells/mm3, 8 of these patients (66%) were newly diagnosed. The average age of the seropositive population was 58 ± 6.5 years and 66 ± 8.5 years for THA and TKA, respectively (p = 0.03). Femoral head osteonecrosis was the underlying pathology for 65.38% (n = 51) of seropositive patients for THA. Conclusion: The seroprevalence of HIV in patients undergoing THA in our South African institution is greater than the seroprevalence in the general population. The seroprevalence of HIV in THA is significantly greater than that in TKA. This may reflect the association between HIV, HAART and hip joint degeneration. Our findings draw attention to the significant burden HIV has on TJA.
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Affiliation(s)
- Zia Maharaj
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
| | - Jurek Rafal Tomasz Pietrzak
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
| | - Nkhodiseni Sikhauli
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
| | - Dick van de Jagt
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
| | - Lipalo Mokete
- Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, Gauteng 2196, South Africa
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12
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Graham SM, Howard N, Moffat C, Lubega N, Mkandawire N, Harrison WJ. Total Hip Arthroplasty in a Low-Income Country: Ten-Year Outcomes from the National Joint Registry of the Malawi Orthopaedic Association. JB JS Open Access 2019; 4:JBJSOA-D-19-00027. [PMID: 32043050 PMCID: PMC6959913 DOI: 10.2106/jbjs.oa.19.00027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We describe our 10-year experience performing total hip arthroplasty (THA) in patients enrolled in the National Joint Registry of the Malawi Orthopaedic Association.
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Affiliation(s)
- Simon Matthew Graham
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Orthopaedic Research Unit, Groote Schuur Hospital, Cape Town, South Africa.,Aintree University Hospital NHS Trust, Liverpool, United Kingdom
| | - Nicholas Howard
- Aintree University Hospital NHS Trust, Liverpool, United Kingdom
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13
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Gbadamosi SO, Dawit R, Jebai R, Kiplagat S, Taskin T, Madhivanan P. Review on knee and hip arthroplasty outcomes in sub-Saharan Africa. Trop Doct 2019; 50:105-106. [PMID: 31510880 DOI: 10.1177/0049475519875366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Semiu O Gbadamosi
- Graduate Assistant, Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Rahel Dawit
- Graduate Research Assistant, Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Rime Jebai
- Graduate Assistant, Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Sandra Kiplagat
- Graduate Assistant, Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Tanjila Taskin
- Graduate Research Assistant, Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Purnima Madhivanan
- Associate Professor, Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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