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Building Bridges, Not Dependencies: Empowering Local Surgeons as the Future of Global Arthroplasty Outreach
Jose C Alcerro1, Michael J Christie2
1Hagamoslo Juntos Foundation, Barrio La Granja, Tegucigalpa, FM, Honduras.
Background:
Short-term medical missions have provided episodic access to total knee arthroplasty (TKA) in low- and middle-income countries, but concerns persist regarding sustainability and continuity of care. We hypothesized that a Honduran surgeon-led TKA program would achieve clinically meaningful improvements in patient-reported outcomes with complication rates within national registry-reported benchmarks.
Methods:
We retrospectively analyzed consecutive primary TKAs performed from October 2023 to June 2025. Of 120 knee arthroplasties, 20 were excluded (two revisions, three without research consent, seven with incomplete baseline evaluation, and eight without complete follow-up), leaving 100 primary TKAs with paired data at 9 to 15 months (mean age 68 years; 80.0% women). Comorbidity burden was assessed using the Goldman cardiac risk index (99.0% class I to II). The primary outcome was change in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS Jr.). Secondary outcomes included the proportion achieving the minimal clinically important difference (≥ 14.0 points), the proportion reaching KOOS Jr ≥ 71.0 (national registry-reported benchmark), and 90-day complications. Multivariable linear regression evaluated predictors of KOOS Jr improvement.
Results:
The mean KOOS Jr. score improved from 33.2 ± 12.6 to 88.6 ± 9.6 (mean improvement, 55.3 points; P < 0.001). All patients achieved the minimal clinically important difference, and 92.0% reached KOOS Jr. ≥ 71.0. There were five patients (5.0%) who had a 90-day complication; periprosthetic joint infection and reoperation rates were both 2.0%. Lower baseline KOOS Jr. predicted greater improvement; Goldman class was not associated with KOOS Jr. change.
Conclusions:
A locally led TKA program in Honduras produced large functional gains and low complication rates comparable to national registry-reported benchmarks, supporting investment in sustainable, surgeon-led arthroplasty capacity in low-resource settings.
Level Of Evidence:
IV.
