Beyond Case Counts: Defining Quality and Accountability in Short-Term Arthroplasty Missions.

Area of Science:

• Orthopaedic Surgery
• Global Health
• Health Systems Research

Background:

• Short-term surgical missions increase access to total joint arthroplasty (TJA) for degenerative joint disease.
• Current reporting often focuses on procedural volume and early outcomes, potentially overestimating success.
• Durable TJA quality requires long-term metrics like implant survivorship and complication management.

Purpose of the Study:

• To examine the limitations of current reporting practices in mission-based TJA.
• To propose an accountability framework for evaluating the sustained impact of TJA missions.
• To ensure episodic interventions lead to durable patient benefit and robust local systems.

Main Methods:

• Critical analysis of current reporting standards for short-term surgical missions in TJA.
• Development of a proposed accountability framework for mission-based arthroplasty.
• Focus on safety surveillance, follow-up, implant traceability, revision capacity, and financial transparency.

Main Results:

• Current metrics for mission-based TJA (volume, early complications) are insufficient for assessing long-term quality.
• Incomplete long-term tracking and local capacity hinder comprehensive outcome evaluation.
• A standardized framework is necessary to move beyond procedural throughput.

Conclusions:

• Episodic TJA interventions must be assessed by durable outcomes, not just surgical volume.
• An accountability framework is crucial for ensuring patient benefit and strengthening local healthcare infrastructure.
• Standardized quality metrics are essential for the sustainable growth of global TJA efforts.