RESEARCH ARTICLE


Pre-Operative Status and Quality of Life Following Total Joint Replacement in a Developing Country: A Prospective Pilot Study



Nina N. Niu*, 1, 2, Jamie E. Collins1, 2, 6, Thomas S. Thornhill2, Luis Alcantara Abreu7, Roya Ghazinouri4, Kanu Okike2, Jeffrey N. Katz1, 2, 3, 5
1 Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA
2 Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA
3 Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA
4 Department of Rehabilitation Services, Physical Therapy, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA
5 Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
6 Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston MA 02118, USA
7 Department of Orthopedic Surgery, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic


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Creative Commons License
© Niu et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA; Tel: 617-645-7289; E-mail: Nina_Niu@hms.harvard.edu


Abstract

Background:

An increasing number of medical relief organizations have launched programs to perform total joint replacements in the developing world. There is a paucity of data on the clinical outcomes of these procedures. We documented pre- and post-operative pain and functional status in a group of low income Dominicans who underwent total hip or knee replacement performed by an American relief organization.

Methods:

In March 2009 and 2010, we surveyed patients participating in Operation Walk Boston, a medical relief organization that provides total joint replacements to patients in the Dominican Republic. Questionnaires included the Western Ontario and McMaster University Osteoarthritis (WOMAC) Index scales and the Short-Form 36 (SF-36) scales for physical activity and mental health. Scores were transformed to a 0 - 100 point scale (100 is best).

Results:

81 individuals (mean age 61 years, 60% female) completed the pre-operative questionnaires. Twenty eight of the 35 who completed preoperative forms in 2009 also completed follow up forms in 2010 (follow-up rate 80%). Patients reported poor pre-operative WOMAC function (mean = 33.6, sd = 22.0) and WOMAC pain (mean = 38.4, sd = 22.9) scores preoperatively. Mean post-operative WOMAC pain and function scores were 86.4 (sd = 13.1) and 88.1 (sd = 11.4) respectively. Improvement in pain and function was similar for patients undergoing hip (n=11) and knee (n=17) replacements.

Conclusion:

Total joint replacement was effective in relieving pain and restoring function in this program. These results are useful for comparison to outcomes in developed countries and for establishing benchmarks for future programs.

Keywords: Arthritis, total joint replacement, global health, quality-of-life.