The state of total Hip replacements in the developing world

Total hip arthroplasty is a fantastic operation that massively improve the patient’s quality of life. Most hospitals in the western world have access to state-of-the-art facilities which aid them with the surgery. In low-income countries, this access is limited. So how does it compare?

A study from Malawi [1] was chosen, as the first study to follow up on patients >10 years in a low-income country. The results are staggeringly positive and can even be compared to registries of high-income countries [2].

A 10-year mortality was at 20% (Malawi) vs 25% (UK) and a revision rate of 8% vs 5%. The Harris hip scores also compared rather favorably with high income countries. This is mainly attributed to the lower age of patients at an average of 52 years (Malawi) vs 68 (UK)

It should be noted that this was a relatively small study of only 70 patients, but one must bear in mind that only 3 hospitals in Malawi (a country with a population of 20 million) has the capability of performing a THA operation, and that patients live long distances from the hospital meaning they cannot afford the return journey.

Complications such as infection and dislocation are known as notable complications for this operation in low-income countries, but were not met in this study.
I think that this study reflects how well we can service people in need even in the poorest of conditions, and makes us think what good we could do by aiding countries like Malawi to improve their medical infrastructure.



[1] Graham SM, Howard N, Moffat C, Lubega N, Mkandawire N, Harrison WJ. Total Hip Arthroplasty in a Low-Income Country: Ten-Year Outcomes from the National Joint Registry of the Malawi Orthopaedic Association. JB JS Open Access. 2019
[2] National Joint Registry for England. Wales, Northern Island and Isle of Man. 14th annual report


This article was written by Ben Clegg part of an ongoing series of scientific communications written and curated by BioTrib’s Early Stage Researchers.

Ben is researching the Wear particle characterization and bio-compatibility of newly 3D printed self-lubricating polymer composites in total joint replacements at Luleå University of Technology, Sweden.