LSTM Home > LSTM Research > LSTM Online Archive

Total Hip Arthroplasty in a Low-Income Country

Graham, Simon, Howard, Nicholas, Moffat, Chipiliro, Lubega, Nicholas, Mkandawire, Nyengo and Harrison, William J. (2019) 'Total Hip Arthroplasty in a Low-Income Country'. JBJS Open Access, Vol 4, Issue 4, e0027.

Total_Hip_Arthroplasty_in_a_Low_Income_Country_.10.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (145kB) | Preview


We describe our 10-year experience performing total hip arthroplasty (THA) in patients enrolled in the National Joint Registry of the Malawi Orthopaedic Association.
Eighty-three THAs were performed in 70 patients (40 male and 30 female) with a mean age of 52 years (range, 18 to 77 years). The cohort included 24 patients (14 male and 10 female; mean age, 52 years [range, 35 to 78 years]) who were human immunodeficiency virus (HIV)-positive.
The main indications for surgery were osteonecrosis (n = 41 hips) and osteoarthritis (n = 26 hips). There were no deaths perioperatively and no early complications at 6 weeks. Forty-six patients (59 THAs) were seen at 10 years postoperatively, with a mean Harris hip score (HHS) of 88 (range, 41 to 91) and a mean Oxford Hip Score (OHS) of 46 (range, 25 to 48). Five hips (8% of 59) were revised due to loosening (n = 4) and fracture (n = 1). There were no infections or dislocations. Fourteen patients died, including 4 HIV-positive patients, of unknown causes in the follow-up period, and 10 patients were lost to follow-up. In the group of 24 HIV-positive patients, there were no early complications, and the mean HHS was 88 (range, 76 to 91) at >10 years.
Our 10-year experience and long-term outcomes after primary THA in a low-income setting show that good results can be achieved within a controlled hospital environment, thereby establishing a benchmark against which other hospitals and registries in similar low-income countries can compare their results.
Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WE Musculoskeletal System > WE 100 General works
WE Musculoskeletal System > WE 800 Extremities > WE 850 Lower extremity. Hip. Leg. Foot.
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 17 Feb 2020 12:21
Last Modified: 17 Feb 2020 12:21


View details

Actions (login required)

Edit Item Edit Item