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

Area of Science:

• Orthopedic surgery
• Public health in Africa
• Systematic reviews

Background:

• Arthroplasty outcomes in sub-Saharan Africa are underreported.
• This study addresses the knowledge gap regarding total hip replacement (THR) and total knee replacement (TKR) in the region.
• Exclusion of South African studies provides a focused regional perspective.

Purpose of the Study:

• To systematically review and report on arthroplasty outcomes in sub-Saharan Africa, excluding South Africa.
• To analyze indications, complication rates, and patient-reported outcomes for THR and TKR.
• To compare findings with high-income country benchmarks.

Main Methods:

• Comprehensive search of Scopus, EMBASE, Medline, and PubMed databases.
• Utilized MeSH headings and Boolean search strategies for systematic literature retrieval.
• Included 12 papers detailing 606 total hip replacements and 763 total knee replacements.

Main Results:

• Osteoarthritis was the primary indication for TKR, while avascular necrosis was most common for THR.
• Observed HIV prevalence up to 33% in the studied populations.
• Reported comparable complication rates to high-income countries, with THR dislocation at 1.6% and deep infection rates of 0.5% (THR) and 1.6% (TKR).

Conclusions:

• Arthroplasty in sub-Saharan Africa demonstrates positive patient-reported outcomes and complication rates comparable to high-income nations.
• Significant reporting bias is suspected, highlighting the need for improved data collection.
• Implementation of mandatory arthroplasty registries is crucial for accurate regional monitoring and future research.