Hu Daniel A, Harold Ryan E, de Cândida Soares Pereira Emanuelle, Trindade Cavalcante Erika, Paula Mariz da Silveira Barros Maria, Nunes Medeiros de Souza Synara, Souza Julio, Brander Victoria A, Stulberg S David
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Federal University of Pernambuco, Recife, PE, Brazil.
Arthroplast Today. 2021 Jul 9;10:41-45. doi: 10.1016/j.artd.2021.05.023. eCollection 2021 Aug.
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.
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.
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 ( = .003) and PROMIS-SF Pain Interference scores ( = .01) than males, and patients with rheumatoid arthritis had more improvement in PROMIS-SF Pain Interference scores ( = .008) compared with all other diagnoses.
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.
全髋关节置换术（THA）是一种非常成功的手术，但在许多资源匮乏的国家却受到限制。作为回应，全球各组织开展了服务之旅，为服务不足的人群提供关节置换护理。目前与这些服务之旅相关的结果数据很少。我们的研究旨在证明在资源匮乏的环境中跟踪全髋关节置换术后患者报告的结果和并发症的可行性，并且这些结果与发达国家的结果相当。
2017年我们完成了一次前往巴西的关节置换服务之旅，在那里我们为38名患者进行了46例全髋关节置换术。患者的平均年龄为48.8岁。47%为女性。在术前以及术后2周、6周、12周和1年收集患者报告的结果评分。进行多变量回归分析以确定患者因素与12周结果之间的关联。
与基线相比，术后2周、6周、12周和1年时，平均改良Harris髋关节评分、髋关节残疾和骨关节炎结果评分、患者报告结果测量信息系统简表（PROMIS-SF）疼痛干扰评分以及PROMIS-SF身体功能评分均有显著改善。在1年时，通过电话随访仅能联系到29%的患者（38名中的11名）。12周时的多变量回归分析发现，女性在髋关节残疾和骨关节炎关节置换结果评分（P = .003）以及PROMIS-SF疼痛干扰评分（P = .01）方面的改善比男性更多，与所有其他诊断相比，类风湿关节炎患者在PROMIS-SF疼痛干扰评分方面的改善更多（P = .008）。
资源匮乏国家的患者从来访手术团队进行的全髋关节置换术中显著受益。然而，在资源匮乏国家，患者出院后很难进行随访。
