Total Knee Arthroplasty in Lubumbashi (DR Congo): Preliminary Results in a Low-Resource Setting

Abstract

Introduction Total Knee Arthroplasty (TKA) is the gold standard treatment for advanced gonarthrosis, but its availability remains limited in low-resource settings. This study presents preliminary outcomes of TKA performed in Lubumbashi. Methods A retrospective, single-center study was conducted on patients who underwent TKA between August 2017 and August 2024. Data collected included demographic, clinical, radiological, and functional variables. Pre and postoperative assessments were based on the International Knee Society (IKS) score. All surgeries were performed using posterior-stabilized prostheses. Postoperative follow-up averaged 24 months. Results A total of 27 patients were included in this series. The mean age was 63.3 years, with a female predominance (sex ratio 0,7). Gonarthrosis was primary in 82% of cases, with advanced radiographic stages Ahlbäck IV-V in 89%. The average preoperative IKS score was 104, improving to 172 postoperatively. Complications included one hematoma, one deep vein thrombosis, two superficial infections, and two cases of late-onset medial laxity. Two patients experienced persistent severe pain, and two cases of prosthetic loosening were detected after two years. Overall, 82.5% of patients achieved good to excellent outcomes. Discussion This study confirms that total knee arthroplasty is feasible and effective in a resource-limited environment when surgical technique and perioperative management are adapted to local constraints. Despite infrastructural and economic barriers, functional outcomes and complication rates were comparable to other African series. The progressive improvement observed reflects the institutional learning curve, strengthened by international collaboration and protocol standardization. Persistent challenges include limited implant supply, inadequate rehabilitation infrastructure, and lack of health insurance coverage. Expanding training programs, improving logistics, and developing regional arthroplasty registries remain essential for sustainable progress. Conclusion TKA can be successfully implemented in sub-Saharan provided that surgical indications are appropriate and perioperative protocols are rigorously applied