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Total joint replacement surgery in a rural centre


Mr Grant D. Stewart, Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary, Edinburgh, UK. Email:


Objective: To demonstrate that total joint replacement surgery can be safely and effectively performed in rural hospitals with acceptable outcomes.

Design: Case series.

Setting: A rural district hospital.

Participants: Participants were 64 patients, 30 men and 34 women, who underwent total knee replacements (TKR); and 63 patients, 41 men and 22 women, who had total hip replacements (THR).

Main outcome measures: Level of patient satisfaction following total joint replacement surgery, obtained by patient interview. Incidence of postoperative joint specific complications, for example infection, THR dislocation and manipulation under anaesthetic (MUA) of a TKR.

Results: None of the TKR or THR patients developed a deep wound infection. In this study 8.8% TKR patients had an MUA but all during a period of limited physiotherapy services; 5.8% THR patients suffered a dislocated prosthesis. Following TKR 95.3% patients reported to be ‘happy’ with the outcome of their surgery. Of the THR patients 97.0% declared they were ‘happy’ with their surgical outcome.

Conclusions: There was a high level of patient satisfaction, low infection rate, acceptable levels of MUA for TKR and dislocation for THR following total joint replacement in our rural district hospital. The surgeons performed a medium volume of total joint replacements and an appropriate multidisciplinary team was in place. In such settings joint replacement surgery can be safely and successfully performed in rural centres to the benefit of rural patients, surgeons and GPs.