Tissue Engineering Unit, Department of Chemical Engineering, University of Bath, Bath, UK.
West Hertfordshire NHS Trust, St. Joseph's Orthopaedic Hospital, Koforidua, Ghana.
Int Orthop. 2019 May;43(5):1041-1047. doi: 10.1007/s00264-019-04286-1. Epub 2019 Jan 24.
With the continued and effective transfer of orthopaedic knowledge and skills across continents, the incidence of hip and knee replacement surgery has increased in the developing world. More patients are having these procedures done locally rather than having to travel over to the more developed western countries at great financial costs for those who cannot really afford it. We report the data collected by an orthopaedic charity MOTEC LIFE UK which has been offering hip and knee arthroplasty procedures to patients who require them. The time period of the procedures was February 2013-October 2017.
The data was collated prospectively and this included age, sex, indication for procedure, and side of procedure (including if bilateral). The information on hip implants used were also collected-implant type (cemented or uncemented), type of bearing surface, size of acetabular cup, liner, femoral head size, and stem size and including if screws were used to augment the fixation of the femoral cup. For the knee implants used, information on the type of implant (semi-constrained, cruciate retaining, or Stanmore hinge knee prosthesis), femoral and tibia stem size, insert type (fixed bearing or mobile bearing), and size; patella button size (whether patella replacement or circumcision) were collected. The surgical approach used in both knee and hip arthroplasty cases was noted.
It is seen from the data collected that a total of 113 hip arthroplasty procedures from 109 patients were carried out and for total knee replacements, 82 knee arthroplasty procedures from 76 patients were carried out. The above procedures were carried out in two separate hospitals. Degenerative osteoarthritis still remains the main indication for hip and knee arthroplasty surgery in our study and this is similar to other joint registries around the world. It was noted that the incidence of avascular necrosis as an indication hip surgery was higher than that seen in registries for developed countries. The mean age for the hip and knee replacement patient in our data was much lower than that what is obtained in the developed world. Furthermore, it was observed that there was increased use of semi-constrained knee prosthesis due to the severe osteoarthritic deformities noted in the patients seen when compared to rate of use of similar implants in the developed world.
This observational study could serve as a springboard for establishment of arthroplasty registries for countries in the sub-region as a whole.
随着骨科知识和技术在各大洲的持续有效转移，发展中国家的髋关节和膝关节置换手术的发病率有所上升。更多的患者选择在当地进行这些手术，而不是前往费用高昂的发达国家。我们报告了一家名为“MOTEC LIFE UK”的骨科慈善机构收集的数据，该机构一直为需要髋关节和膝关节置换手术的患者提供此类手术。手术时间为 2013 年 2 月至 2017 年 10 月。
数据是前瞻性收集的，包括年龄、性别、手术指征和手术侧（包括双侧）。还收集了髋关节植入物的信息，包括植入物类型（骨水泥型或非骨水泥型）、关节面类型、髋臼杯大小、衬垫、股骨头大小、股骨柄大小，以及是否使用螺钉增强股骨杯固定。对于使用的膝关节植入物，收集了植入物类型（半限制型、保留交叉韧带型或 Stanmore 铰链膝关节假体）、股骨和胫骨柄大小、插入物类型（固定轴承或活动轴承）和大小；髌骨扣大小（髌骨置换或环割）的信息。记录了膝关节和髋关节置换手术中使用的手术入路。
从收集的数据中可以看出，共对 109 名患者的 113 例髋关节置换手术和 76 名患者的 82 例全膝关节置换手术进行了治疗。上述手术在两家不同的医院进行。退行性骨关节炎仍然是我们研究中髋关节和膝关节置换手术的主要指征，这与世界各地的其他关节登记处相似。值得注意的是，作为髋关节手术指征的股骨头缺血性坏死的发生率高于发达国家登记处的报告。我们数据中髋关节和膝关节置换患者的平均年龄明显低于发达国家的报告。此外，与发达国家类似植入物的使用率相比，由于患者存在严重的骨关节炎畸形，我们观察到半限制型膝关节假体的使用有所增加。
这项观察性研究可以为整个次区域国家建立关节置换登记处提供一个起点。
