International comparative analysis to understand the capacity for arthroscopy training and practice in developing countries

Abstract

PurposeArthroscopy is an efficacious and popular treatment modality in developed nations for a variety of musculoskeletal conditions. However, arthroscopy requires specialized training, complex infrastructure, and expensive equipment, occasionally causing barriers to use in developing countries. Consequently, the utilization of resources to perform and teach arthroscopy in low- and middle-income countries (LMICs) is controversial. Through this investigation, we assessed the current capacity and barriers to arthroscopy use and training in these settings.MethodsFocused interviews were conducted with surgeons from Haiti (low-income) and Romania (middle-income) regarding their experience with arthroscopy. Based on responses, a multiple-choice survey was developed and administered to orthopaedic trainees and practicing orthopaedic surgeons during national orthopaedics conferences in each country.ResultsFifty-eight orthopaedists in Haiti, and 29 in Romania completed the survey. Most (91% from Haiti; 79% from Romania) reported that learning arthroscopy is essential or important for orthopaedic training in their country. Yet only 17% from Haiti compared to 69% from Romania indicated their primary hospital has the equipment necessary for arthroscopy. In Haiti, equipment was the main barrier to use of arthroscopy, followed by training, while in Romania, the main barrier was training, followed by equipment. Simulations and telemedicine were ranked as top choices of effective methods for learning arthroscopy.ConclusionsRegardless of their country’s resource limitations, most participants place high value on the practice of arthroscopy and arthroscopic training. The results from this study highlight a hierarchy of needs in developing nations. Furthermore, local providers report a strong belief in the need for arthroscopic treatment to benefit their patients, and a clear desire for further training and development of these techniques. By identifying similarities and differences by location, we may better tailor global orthopaedic training initiatives and partnerships in LMICs.