Patients in Zimbabwe who have traditionally had to travel abroad or rely on expensive private healthcare for hip and knee replacement surgeries could soon have a more affordable option following the expansion of joint replacement services at Mpilo Central Hospital in Bulawayo.
Joint replacement surgery has historically cost about US$10 000 in Zimbabwe’s private institutions, forcing some patients who could not afford it to seek treatment outside the country, including in India, China and South Africa.
This is set to change as Mpilo expands its joint replacement services, with the hospital now performing hip replacements and preparing to conduct its first knee replacement on Thursday under the guidance of Italian orthopaedic specialist Professor Alessandro Lelli, who is visiting the hospital to train local surgeons.
Beyond treating patients, the initiative is expected to strengthen specialist capacity at Mpilo, which is also a teaching institution.
Professor Lelli’s involvement will allow local surgeons to work alongside an international specialist and acquire skills that can be applied to future patients, creating a model of knowledge transfer rather than reliance on visiting specialists to provide one-off procedures.
On Wednesday, two hip replacement operations were performed at the hospital, one on an elderly woman and another on a 36-year-old man who sustained a serious injury while playing social soccer.
CITE witnessed one of the procedures in action.
Orthopaedic surgeon Dr Jabu Mthethwa, born and raised in Bulawayo before spending about two decades in Scotland for his training, said a team of 10 surgeons was involved in the initiative.
“Professor Lelli from Italy will be coming in tomorrow and what he is going to teach us and provide locally is our first knee replacement at Mpilo Hospital,” he said.
“We have a total of four cases lined up over the next couple of days.”
Dr Mthethwa said the programme was intended not only to perform life-changing operations but also to build confidence in Zimbabwe’s public healthcare system and expand the skills of local surgeons.
He said he had been performing hip replacements in Bulawayo for about three years, initially introducing the procedures at United Bulawayo Hospitals.
“These operations return people to function. Mobility is key for anybody to be a breadwinner and just pure survival,” he said.
“The conditions affecting the patients we are doing over the next four days have rendered them in constant pain and immobile.”
The latest initiative, Dr Mthethwa said, was an opportunity to broaden local knowledge while demonstrating that complex orthopaedic procedures could be safely performed in Zimbabwe’s public hospitals.
“We have already had great successes with the hip replacement and we hope we have the same success with knee replacements,” he said.
The development comes against a backdrop of limited access to joint replacement surgery in Zimbabwe, where patients have historically travelled abroad to access the procedures.
Even where the procedures have been available locally, they have largely been confined to private institutions and have been prohibitively expensive for many patients.
“Historically it cost upwards of US$10 000 here in Zimbabwe, which is a massive cost. But this is because these were only provided within private institutions,” Dr Mthethwa said.
However with specialist services now extended through public institutions and partnerships with suppliers and sponsors, he said the cost could be brought down significantly to about US$2 000, although there was scope to bring it down further through greater government involvement and support from suppliers.
“I just feel that mobility is a life right. Financial barriers should not exist in providing the best care for people to get back up mobile and earning and living and providing to the economy of any country,” Dr Mthethwa said.
To patients suffering from advanced osteoarthritis and other debilitating joint conditions, the procedures can mean the difference between dependence and independence.
Dr Mthethwa explained undergoing joint replacement surgery can be “a scary prospect” for patients because it involves having an artificial component placed inside the body.
“People often worry about having something foreign put inside them. We use various materials, ranging from titanium and stainless steel to cobalt-chromium, but most of the implants currently on the market are titanium-based,” he said.
He explained in a hip replacement, the damaged parts of the joint are replaced with artificial components.
“What’s important in hip replacement is that we replace the socket. The hip is a ball-and-socket joint, so we replace the socket with an artificial one,” Mthethwa said.
He said the implants are designed to restore natural movement, allowing patients to resume activities that had previously become difficult or impossible because of pain and restricted mobility.
“People actually get back to running, going to the gym, walking independently and they actually don’t remember they have metal in them,” he said.
Dr Prince Gwetu, an orthopaedic surgeon and trauma specialist at Mpilo, added the burden of joint disease was much greater than many people realised.
“We find that the burden of joint disease, which is debilitating, is so vast, but however, most of our patients don’t know it,” he said.
Patients presenting with painful joints are first assessed to establish the extent of the damage and the level of disability before undergoing further investigations to determine whether they are suitable for surgery.
Since joint replacement is not automatically recommended, Dr Gwetu said doctors initially consider less invasive options such as medication, weight management, exercise and pain management.
Surgery is considered when these interventions fail and the patient’s condition warrants replacement.
Dr Gwetu said many Zimbabweans were unaware the procedures were increasingly becoming available locally.
“Most people are accessing these services as far as India, China and South Africa. I am telling the public that these services are actually available locally at affordable rates in the government hospital,” he said.
The need for the service is significant, particularly as Zimbabwe’s population grows and life expectancy increases.
Gwetu said the hospital’s waiting lists for joint replacement surgeries were already long.
“The waiting list is quite vast because the burden is quite huge because most of our population is increasing in size and also increasing in terms of life expectancy,” he said.
Conditions such as osteoarthritis are particularly common among older people, while access to specialist healthcare remains more difficult for patients living in rural areas.
“Unfortunately, most of these patients are from rural areas where access to health is a bit limited. The burden is quite huge than what we expect,” Dr Gwetu said.
He said greater public awareness could encourage patients to seek help earlier rather than assuming that chronic joint pain and immobility were simply part of aging.
Dr Mthethwa said the team hoped to conduct joint replacement camps as frequently as resources allowed, with the biggest challenge being the cost of implants.
“As long as the numbers are there, then you can kind of get the teams down. Moving people around to try and make these things happen is obviously a massive endeavour,” he said.
“Apart from that barrier, we can actually do these a lot more often.”
The programme also highlights the importance of Mpilo’s role as a training institution, with visiting specialists providing an opportunity for local surgeons to acquire and refine specialised skills.
Rather than simply bringing in foreign specialists to perform procedures, the model allows visiting experts to work alongside Zimbabwean surgeons and transfer knowledge that can subsequently be used to treat more patients locally.
“We have expertise across all platforms and this is the reassurance that I want to give to Zimbabweans,” summed Dr Mthethwa.
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