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[Translated article] Challenges in implementing a total hip arthroplasty program in a developing country: Our
V Barro1, C Carbonell-Rosell1, J Ribera2
1Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Insights
Implementing total hip arthroplasty (THA) in sub-Saharan Africa is feasible, improving patient quality of life. This study details challenges and outcomes of a THA program in the Democratic Republic of Congo.
Area of Science:
- Orthopedic Surgery
- Global Health
- Arthroplasty
Background:
- Access to total hip arthroplasty (THA) is limited in sub-Saharan Africa due to various challenges.
- Hip osteoarthritis significantly impacts quality of life, necessitating surgical intervention.
Purpose of the Study:
- To describe the implementation of a THA program at Monkole Hospital, Democratic Republic of Congo.
- To identify technical challenges and surgical complications encountered during THA in a resource-limited setting.
- To share experiences to guide similar programs in developing countries.
Main Methods:
- Eight THA surgery campaigns conducted between July 2019 and February 2023.
- Prospective collection of demographic and surgical data, including technical difficulties and complications.
- Follow-up managed by a local orthopedic surgeon.
Main Results:
- Seventy-three THA procedures performed on 63 patients (mean age 34 years) with a 24-month follow-up.
- Seventeen intraoperative technical incidents (23.2%) and a 9.5% postoperative complication rate.
- Three patients required revision surgery due to complications.
Conclusions:
- THA is feasible and cost-effective in developing countries with adequate infrastructure, trained teams, and implant availability.
- Investing in local surgeon training and resources is crucial for program sustainability and improved surgical care.
- Successful THA programs enhance patient quality of life in resource-limited settings.
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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