Patient-Reported Outcomes After Total Hip Arthroplasty in a Low-Resource Country by a Visiting Surgical Team

Daniel A Hu; Ryan E Harold; Emanuelle de Cândida Soares Pereira; Erika Trindade Cavalcante; Maria Paula Mariz da Silveira Barros; Synara Nunes Medeiros de Souza; Julio Souza; Victoria A Brander; S David Stulberg

doi:10.1016/j.artd.2021.05.023

Patient-Reported Outcomes After Total Hip Arthroplasty in a Low-Resource Country by a Visiting Surgical Team

Arthroplast Today. 2021 Jul 9:10:41-45. doi: 10.1016/j.artd.2021.05.023. eCollection 2021 Aug.

Authors

Daniel A Hu¹, Ryan E Harold¹, Emanuelle de Cândida Soares Pereira², Erika Trindade Cavalcante², Maria Paula Mariz da Silveira Barros², Synara Nunes Medeiros de Souza², Julio Souza³, Victoria A Brander¹, S David Stulberg¹

Affiliations

¹ Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
² Federal University of Pernambuco, Recife, PE, Brazil.
³ Hospital Dom Helder Câmara, Cabo de Santo Agostinho, PE, Brazil.

Abstract

Background: Total hip arthroplasty (THA) is a highly successful procedure but limited in many low-resource nations. In response, organizations globally have conducted service trips to provide arthroplasty care to underserved populations. Few outcomes data are currently available related to these trips. Our study aims to demonstrate the feasibility of tracking patient-reported outcomes and complications after THA in a low-resource setting and that outcomes are comparable to those in developed countries.

Methods: We completed an arthroplasty service trip to Brazil in 2017 where we performed 46 THAs on 38 patients. The mean patient age was 48.8 years. Forty-seven percent were female. Patient-reported outcome scores were collected preoperatively and postoperatively at 2, 6, and 12 weeks and 1 year. A multivariate regression analysis was performed to identify associations between patient factors and 12-week outcomes.

Results: The mean modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, Patient-Reported Outcome Measurement Information System Short Form (PROMIS-SF) Pain Interference, and PROMIS-SF Physical Function all improved significantly compared to baseline at 2, 6, and 12 weeks and 1 year postoperatively. At 1 year, only 29% of patients (11 of 38) were reachable by phone for follow-up.Multivariate regression analysis at 12 weeks found that females had more improvement in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores (P = .003) and PROMIS-SF Pain Interference scores (P = .01) than males, and patients with rheumatoid arthritis had more improvement in PROMIS-SF Pain Interference scores (P = .008) compared with all other diagnoses.

Conclusion: Patients in low-resource countries benefitted significantly from THA performed by a visiting surgical team. However, following up patients is difficult in low-resource countries once they leave the hospital.

Keywords: Clinical outcomes; International mission trip; Low-resource community; Primary total hip arthroplasty.