Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Plenge, U; Parker, R; Davids, S; Davies, GL; Fullerton, Z; Gray, L; Groenewald, P; Isaacs, R; Kauta, N; Louw, FM; Mazibuko, A; North, DM; Nortje, M; Nunes, GM; Pebane, N; Rajah, C; Roos, J; Ryan, P; September, WV; Shanahan, H; Siebritz, RE; Smit, RW; Sombili, S; Torborg, A; van der Merwe, JF; van der Westhuizen, N; Biccard, B

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Journal article

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Abstract:: Background: Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Recently, this is further exacerbated by the impact of the Covid-19 Pandemic on elective surgeries. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level. Methods: Retrospective review of consecutive hip and knee primary arthroplasty cases performed at a District Hospital (DH), and a Tertiary Academic Hospital (TH) in Cape Town, South Africa between 1st January 2015 and 31st December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts. Results: Seven hundred and ninety-five primary arthroplasty surgeries were performed at TH level and 228 at DH level. The average hospital stay was 5.2±2.0 days at DH level and 7.6±7.1 days for TH (p0.05). Periprosthetic joint infection (PJI) rate was 0.43% at DH and 2.26% at TH. The percentage of hip dislocation requiring revision was 0% at district and 0.37% at tertiary level. During the study period, 228 patients received their arthroplasty surgery at the DH; these patients would otherwise have remained on the TH waiting list. Conclusions: Hip and Knee Arthroplasty at District health care level is safe and; for the reason that the DH feeds into the TH; providing arthroplasty at district level may help ease the pressure on arthroplasty services at tertiary care facilities in a Southern African context. Adequately trained surgeons should be encouraged to perform these procedures in district hospitals provided there is appropriate patient selection and adherence to strict theatre operating procedures

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Plenge, U., Parker, R., Davids, S., Davies, G. L., Fullerton, Z., Gray, L., Groenewald, P., Isaacs, R., Kauta, N., Louw, F. M., Mazibuko, A., North, D. M., Nortje, M., Nunes, G. M., Pebane, N., Rajah, C., Roos, J., Ryan, P., September, W. V., … Biccard, B. (2020). Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study. BMC Musculoskeletal Disorders, 21(1).

MLA Style

Plenge, U, et al. “Quality of Recovery after Total Hip and Knee Arthroplasty in South Africa: a National Prospective Observational Cohort Study.” BMC Musculoskeletal Disorders, vol. 21, no. 1, 2020.

Chicago Style

Plenge, U, R Parker, S Davids, et al. 2020. “Quality of Recovery after Total Hip and Knee Arthroplasty in South Africa: a National Prospective Observational Cohort Study.” BMC Musculoskeletal Disorders 21 (1).
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