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Challenges in implementing a total hip arthroplasty program in a developing country: Our experience at Monkole
V Barro1, C Carbonell-Rosell1, J Ribera2
1Hospital Universitari Vall d'Hebron, Barcelona, España.
Insights
Implementing total hip arthroplasty (THA) in Sub-Saharan Africa is feasible, despite challenges. This program improved patient quality of life, demonstrating the procedure
Area of Science:
- Orthopedic Surgery
- Global Health
Background:
- Total hip arthroplasty (THA) is crucial for hip osteoarthritis but faces access barriers in Sub-Saharan Africa.
- Monkole Hospital, DRC, established a THA program to address these challenges.
Purpose of the Study:
- To describe the implementation of a THA program in a low-resource setting.
- To detail technical challenges and surgical complications encountered.
- To share experiences for similar initiatives.
Main Methods:
- Eight THA campaigns conducted between July 2019 and February 2023.
- Prospective data collection on demographics, surgical details, difficulties, and complications.
- Follow-up by a local orthopedic surgeon.
Main Results:
- 73 THA surgeries performed on 63 patients (mean age 34 years).
- 17 intraoperative technical incidents (23.2%) and a 9.5% postoperative complication rate.
- 3 patients required revision surgery.
Conclusions:
- THA is feasible and cost-effective in developing countries with adequate infrastructure and training.
- Local surgeon training and resource investment are vital for program sustainability.
- Successful THA implementation significantly improves patient quality of life.
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.
