Evaluating the Social Impact of a Proposed Orthopedic Center of Excellence in Northern Tanzania: A Novel Use of the Impact Multiple of Money Methodology.

BACKGROUND: Musculoskeletal injuries-often a result of Road Traffic Accidents (RTAs)-represent a significant burden in sub-Saharan Africa. RTA victims are faced with lifelong disability and diminished employment. Northern Tanzania in particular lacks the orthopedic surgical capacity needed to provide patients with definitive surgical fixation. While there is great potential in establishing an Orthopedic Center of Excellence (OCE), the precise social impact of such an initiative is currently unknown. METHODS: To demonstrate the social value of an orthopedic OCE in Northern Tanzania, this paper proposes a methodology for calculating social impact. This methodology draws upon RTA-related Disability Adjusted Life Years (DALYs), current and projected surgical complication rates, anticipated changes in surgical volume, and average per capita income to quantify how much social value can be gained by mitigating the impact of RTAs. These parameters can be utilized to calculate an impact multiplier of money (IMM), stating the social returns on each dollar invested. RESULTS: Modeling exercises demonstrate that improvements in the complication rate and surgical volume over the current baseline results in significant social impact. In the best-case scenario, the COE is expected to yield over $131 million over 10 years, with an IMM of 13.19. CONCLUSIONS: Investments in orthopedic care will yield significant dividends, as demonstrated by our novel methodology. The cost-effectiveness of the OCE is comparable to, if not greater, than many other global health initiatives. More broadly, the IMM methodology can be used to quantify the impact of other projects aimed at reducing long-term injury.

Acetabular reconstruction in revision total hip arthroplasty.

The number of total hip arthroplasty (THA) procedures performed annually continues to rise. Specific challenges, including acetabular bone loss, are commonly encountered at the time of revision surgery, and orthopaedic surgeons must be prepared to address them. This review focuses on topics related to acetabular reconstruction, including pre-operative patient evaluation (clinical and radiographic), pre-operative planning, common causes of acetabular failure, classification of acetabular bone loss, methods of acetabular reconstruction, and clinical results based on reconstruction method. Pre-operative patient evaluation for revision THA begins with a thorough history and physical examination as well as laboratory workup to rule out infection. Detailed radiographic evaluation and pre-operative planning are also essential and will facilitate communication amongst all members of the operative team. Although there are several ways to describe acetabular bone loss, the Paprosky classification system - defined by anterosuperior and posteroinferior acetabular column integrity - is the system most commonly used today and will guide treatment strategy. Several treatment strategies have been developed and may be termed either "cemented" (e.g. impaction grafting, ring and cage construction, structural allograft) or "uncemented" (e.g. hemispheric shell ± porous metal augment, cup-cage, custom triflange acetabular component). Although each strategy has its advantages and disadvantages, the general principles remain the same. Successful treatment depends upon detailed pre-operative assessment, planning, and team-based plan execution. Uncemented techniques that allow for biologic fixation are preferred. In the special case of pelvic discontinuity, acetabular distraction is the authors' preferred technique. Longer term studies are still needed to evaluate the longevity of each of the various reconstruction methods presented.