Billy Haonga - Academia.edu (original) (raw)

Papers by Billy Haonga

East African Orthopaedic Journal, Jun 9, 2016

We retrospectively reviewed 30 patients with a diffuse-type giant-cell tumour (Dt-GCT) (previousl... more We retrospectively reviewed 30 patients with a diffuse-type giant-cell tumour (Dt-GCT) (previously known as pigmented villonodular synovitis) around the knee in order to assess the influence of the type of surgery on the functional outcome and quality of life (QOL). Between 1980 and 2001, 15 of these tumours had been treated primarily at our tertiary referral centre and 15 had been referred from elsewhere with recurrent lesions. The mean follow-up was 64 months (24 to 393). Functional outcome and QOL were assessed with range of movement and the Knee injury and Osteoarthritis Outcome Score (KOOS), the Musculoskeletal Tumour Society (MSTS) score, the Toronto Extremity Salvage Score (TESS) and the SF-36 questionnaire. There was recurrence in four of 14 patients treated initially by open synovectomy. Local control was achieved after a second operation in 13 of 14 (93%). Recurrence occurred in 15 of 16 patients treated initially by arthroscopic synovectomy. These patients underwent a mean of 1.8 arthroscopies (one to eight) before open synovectomy. This achieved local control in 8 of 15 (53%) after the first synovectomy and in 12 of 15 (80%) after two. The functional outcome and QOL of patients who had undergone primary arthroscopic synovectomy and its attendant subsequent surgical procedures were compared with those who had had a primary open synovectomy using the following measures: range of movement (114º versus 127º; p = 0.03); KOOS (48 versus 71; p = 0.003); MSTS (19 versus 24; p = 0.02); TESS (75 versus 86; p = 0.03); and SF-36 (62 versus 80; p = 0.01). Those who had undergone open synovectomy needed fewer subsequent operations. Most patients who had been referred with a recurrence had undergone an initial arthroscopic synovectomy followed by multiple further synovectomies. At the final followup of eight years (2 to 32), these patients had impaired function and QOL compared with those who had undergone open synovectomy initially. We conclude that the natural history of Dt-GCT in patients who are treated by arthroscopic synovectomy has an unfavourable outcome, and that primary open synovectomy should be undertaken to prevent recurrence or residual disease.

Background: The rate of open tibia fractures is rapidly increasing across the globe due to a rece... more Background: The rate of open tibia fractures is rapidly increasing across the globe due to a recent rise in road traffic accidents, predominantly in low and low-middle income countries. These injuries are orthopaedic emergencies associated with infection rates as high as 40% despite the use of systemic antibiotics and surgical debridement. The use of local antibiotics has shown some promise in reducing the burden of infection in these injuries due to increasing local tissue availability, however no trial has yet been appropriately powered to evaluate for definitive evidence and the majority of current studies have taken place in a high-resource countries where resources and the bio-burden may be different. • Methods: This is a prospective randomized, masked, placebo-controlled superiority trial designed to evaluate the efficacy of locally administered gentamicin versus placebo in the prevention of fracture-related infection in adults (age>18 years) with primarily closeable Gustil...

OTA International: The Open Access Journal of Orthopaedic Trauma

East African Orthopaedic Journal, 2016

East African Orthopaedic Journal, 2018

African Journal of Disability

Background: The burden of disability because of traumatic limb amputation, particularly transfemo... more Background: The burden of disability because of traumatic limb amputation, particularly transfemoral amputation (TFA) is disproportionately carried by low- and middle-income countries. The need for improved access to prosthesis services in these settings is well-documented, but perspectives on the burden imposed by TFA and the challenges associated with subsequent prosthesis provision vary among patients, caregivers and healthcare providers.Objectives: To examine the burden of TFA and barriers to prosthesis provision as perceived by patient, caregiver and healthcare professional, at a single tertiary referral hospital in Tanzania.Method: Data were collected from five patients with TFA and four caregivers recruited via convenience sampling, in addition to 11 purposively sampled healthcare providers. All participants participated in in-depth interviews regarding their perceptions of amputation, prostheses and underlying barriers to improving care for persons with TFA in Tanzania. A co...

East African Orthopaedic Journal, 2016

Journal of Bone and Joint Surgery

Journal of Bone and Joint Surgery

Background: International orthopaedic resident rotations in low and middle-income countries (LMIC... more Background: International orthopaedic resident rotations in low and middle-income countries (LMICs) are gaining popularity among high-income country (HIC) residency programs. While evidence demonstrates a benefit for the visiting residents, few studies have evaluated the impact of such rotations on the orthopaedic surgeons and trainees in LMICs. The purpose of this study was to further explore themes identified in a previous survey study regarding the local impact of visiting HIC resident rotations. Methods: Using a semistructured interview guide, LMIC surgeons and trainees who had hosted HIC orthopaedic residents within the previous 10 years were interviewed until thematic saturation was reached. Results: Twenty attending and resident orthopaedic surgeons from 8 LMICs were interviewed. Positive and negative effects of the visiting residents on clinical care, education, interpersonal relationships, and resource availability were identified. Seven recommendations for visiting resident rotations were highlighted, including a 1 to 2-month rotation length; visiting residents at the senior training level; site-specific prerotation orientation with an emphasis on resident attitudes, including the need for humility; creation of bidirectional opportunities; partnering with institutions with local training programs; and fostering mutually beneficial sustained relationships. Conclusions: This study explores the perspectives of those who host visiting residents, a viewpoint that is underrepresented in the literature. Future research regarding HIC orthopaedic resident rotations in LMICs should include the perspectives of local surgeons and trainees to strive for mutually beneficial experiences to further strengthen and sustain such academic partnerships.

JAAOS: Global Research and Reviews

The American Journal of Surgery

BACKGROUND Despite interest among North American orthopaedic residents to pursue rotations in res... more BACKGROUND Despite interest among North American orthopaedic residents to pursue rotations in resource-limited settings, little is known regarding resident motivations and impact on host surgeons. METHODS Surveys were distributed to North American orthopaedic surgeons and trainees who participated in international rotations during residency to assess motivations for participation and to orthopaedic surgeons at partnering low- and middle-income country (LMIC) institutions to assess impact of visiting trainees. RESULTS Responses were received from 136 North American resident rotators and 51 LMIC host surgeons and trainees. North American respondents were motivated by a desire to increase surgical capacity at the LMIC while host surgeons reported a greater impact from learning from residents than on surgical capacity. Negative aspects reported by hosts included selfishness, lack of reciprocity, racial discrimination, competition for surgical experience, and resource burdens. CONCLUSIONS The motivations and impact of orthopaedic resident rotations in LMICs need to be aligned. Host perceptions and bidirectional educational exchange should be incorporated into partnership guidelines.

East African Orthopaedic Journal, Apr 4, 2019

Background: Limb amputation, often from road trauma, is common in low-income countries. Providing... more Background: Limb amputation, often from road trauma, is common in low-income countries. Providing prosthetic devices for amputees is challenging and limited research exists regarding barriers to prosthesis provision. This study aims to elucidate the Prosthesis Provision Pathway (PPP) and identify barriers of prosthesis accessibility at the Muhimbili Orthopaedic Institute (MOI) in Dar es Salaam, Tanzania. Patients and Methods: At MOI, 18 healthcare providers, who included 4 orthopaedic technicians, 4 physical therapists, 4 orthopaedic surgeons, 4 junior doctors, and 2 hospital administrators were interviewed and blinded. Responses from semi-structured interviews were transcribed and common themes were identified. A process map diagramming the prosthesis provision pathway was created to highlight barriers and potential areas of improvement. Results: Six main themes emerged from the interviews: the first is that the prosthetics are expensive both for patients and MOI. Second, there are misperceptions of how prosthesis cost will be distributed. Third, there is inefficient communication between providers. Fourth, improved surgical education is needed to improve amputation outcomes. Fifth, amputees face psychosocial stigma, but prosthetics are becoming more accepted. Lastly, healthcare providers understand that trauma is the most common aetiology for amputation. Conclusions: Potential solutions to solving the prosthetic shortage will involve making prostheses more affordable, integrating the orthopaedic prosthesis workshop earlier in the provision process, improving surgical education and communication between providers, and working to prevent road trauma.

Prosthetics & Orthotics International

Journal of Orthopaedic Trauma, 2015

A dissertation submitted in (partial) fulfillment of the Requirements for the Degree ii CERTIFICA... more A dissertation submitted in (partial) fulfillment of the Requirements for the Degree ii CERTIFICATION The undersigned certifies that he has read and hereby recommends for acceptance by Muhimbili University of Health and Allied Sciences as dissertation entitled Early Outcome of Polytrauma Patient Attended at MOI and MNH Emergency Department in (Partial) fulfillment of requirements for the Degree MUHAS for his technical support. I am grateful also to Dr Mosha from the Department of Pathology for assistance in doing post-mortem. I like to convey my thanks to all academic members of staff in the Department of Orthopedic and Trauma MUHAS and MOI for their input during development, follow up analysis of this dissertation. I am grateful to my wife, Evarister S. Ndilila for her support, courage, commitment and taking good care of the family during my study period. I humbly thank almighty God for a good health throughout my study period. v DEDICATIONS This dissertation is dedicated to my bel...

Tanzania Journal of Health Research, 2011

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue... more Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage and is one of the leading complaints in emergency departments (EDs). Despite the important and the advantages of pain control, still patients do not receive appropriate attention. The objective of this study was to assess pain management among adult patients with fractures of long bones at Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. A descriptive Cross-sectional study design (Hospital based) was used. A total of 250 patients aged 18-60 years old with fractures of long bones were recruited from March to June 2008. Structured questionnaires and observation guide were used to collect data. Verbal rating scale was used, to determine the intensity of pain. The study shows that there is no documentation for pain assessment or reassessment at Emergency Department. Slightly above half (54%; 135/250) of patients were not given analgesics. The commonest analgesic given was ...

Tanzania Journal of Health Research

Background: Comminuted femoral shaft fractures are complex to treat because of increased risk of ... more Background: Comminuted femoral shaft fractures are complex to treat because of increased risk of limb length discrepancies and mal-rotation deformities. Currently the interlocking intramedullary nail using image intensifiers is a suggested treatment for comminuted femoral shaft fractures. This study aimed to evaluate the short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary SIGN nail without image intensifiers at Muhimbili Orthopaedic Institute (MOI) in Tanzania.Methods: A prospective hospital base study was conducted on patients with closed comminuted femoral shaft fractures admitted at MOI from March 2011 to February 2012. A total of 91 adult patients (18 to 84 years) were enrolled in the study. Of the total patients, 80 (88%) patients were male, 11 were lost to follow-up, and 80 patients completed follow-ups of 18 weeks post operatively. Structured questionnaires and checklist forms were used to collect information. Opera...

Tanzania Medical Journal, 2020

Background Total hip arthroplasty and hemiarthroplast are currently common procedures in our sett... more Background Total hip arthroplasty and hemiarthroplast are currently common procedures in our setting, Subluxation and periprosthetic facture of the femur has been reported. This can be linked to undersize and oversize of the prosthesis since most of these prosthetics are western standardized. This is partly because of lacking data of the size of the proximal femur. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint. Knowledge about the different diameters of the head, neck and length of femur is essential in orthopedic surgery and radiology and forensic medicine. These normative values are essential for plastic and reconstructive surgeons in their reconstruction and medical rehabilitation. However, the anatomical and anthropological statistical analysis of femoral anthropometry among different populations reveals a great variation for all human races. The present study aimed at determining morphometric measurements of proximal femur among ...

East African Orthopaedic Journal, Jun 9, 2016

We retrospectively reviewed 30 patients with a diffuse-type giant-cell tumour (Dt-GCT) (previousl... more We retrospectively reviewed 30 patients with a diffuse-type giant-cell tumour (Dt-GCT) (previously known as pigmented villonodular synovitis) around the knee in order to assess the influence of the type of surgery on the functional outcome and quality of life (QOL). Between 1980 and 2001, 15 of these tumours had been treated primarily at our tertiary referral centre and 15 had been referred from elsewhere with recurrent lesions. The mean follow-up was 64 months (24 to 393). Functional outcome and QOL were assessed with range of movement and the Knee injury and Osteoarthritis Outcome Score (KOOS), the Musculoskeletal Tumour Society (MSTS) score, the Toronto Extremity Salvage Score (TESS) and the SF-36 questionnaire. There was recurrence in four of 14 patients treated initially by open synovectomy. Local control was achieved after a second operation in 13 of 14 (93%). Recurrence occurred in 15 of 16 patients treated initially by arthroscopic synovectomy. These patients underwent a mean of 1.8 arthroscopies (one to eight) before open synovectomy. This achieved local control in 8 of 15 (53%) after the first synovectomy and in 12 of 15 (80%) after two. The functional outcome and QOL of patients who had undergone primary arthroscopic synovectomy and its attendant subsequent surgical procedures were compared with those who had had a primary open synovectomy using the following measures: range of movement (114º versus 127º; p = 0.03); KOOS (48 versus 71; p = 0.003); MSTS (19 versus 24; p = 0.02); TESS (75 versus 86; p = 0.03); and SF-36 (62 versus 80; p = 0.01). Those who had undergone open synovectomy needed fewer subsequent operations. Most patients who had been referred with a recurrence had undergone an initial arthroscopic synovectomy followed by multiple further synovectomies. At the final followup of eight years (2 to 32), these patients had impaired function and QOL compared with those who had undergone open synovectomy initially. We conclude that the natural history of Dt-GCT in patients who are treated by arthroscopic synovectomy has an unfavourable outcome, and that primary open synovectomy should be undertaken to prevent recurrence or residual disease.

Background: The rate of open tibia fractures is rapidly increasing across the globe due to a rece... more Background: The rate of open tibia fractures is rapidly increasing across the globe due to a recent rise in road traffic accidents, predominantly in low and low-middle income countries. These injuries are orthopaedic emergencies associated with infection rates as high as 40% despite the use of systemic antibiotics and surgical debridement. The use of local antibiotics has shown some promise in reducing the burden of infection in these injuries due to increasing local tissue availability, however no trial has yet been appropriately powered to evaluate for definitive evidence and the majority of current studies have taken place in a high-resource countries where resources and the bio-burden may be different. • Methods: This is a prospective randomized, masked, placebo-controlled superiority trial designed to evaluate the efficacy of locally administered gentamicin versus placebo in the prevention of fracture-related infection in adults (age>18 years) with primarily closeable Gustil...

OTA International: The Open Access Journal of Orthopaedic Trauma

East African Orthopaedic Journal, 2016

East African Orthopaedic Journal, 2018

African Journal of Disability

Background: The burden of disability because of traumatic limb amputation, particularly transfemo... more Background: The burden of disability because of traumatic limb amputation, particularly transfemoral amputation (TFA) is disproportionately carried by low- and middle-income countries. The need for improved access to prosthesis services in these settings is well-documented, but perspectives on the burden imposed by TFA and the challenges associated with subsequent prosthesis provision vary among patients, caregivers and healthcare providers.Objectives: To examine the burden of TFA and barriers to prosthesis provision as perceived by patient, caregiver and healthcare professional, at a single tertiary referral hospital in Tanzania.Method: Data were collected from five patients with TFA and four caregivers recruited via convenience sampling, in addition to 11 purposively sampled healthcare providers. All participants participated in in-depth interviews regarding their perceptions of amputation, prostheses and underlying barriers to improving care for persons with TFA in Tanzania. A co...

East African Orthopaedic Journal, 2016

Journal of Bone and Joint Surgery

Journal of Bone and Joint Surgery

Background: International orthopaedic resident rotations in low and middle-income countries (LMIC... more Background: International orthopaedic resident rotations in low and middle-income countries (LMICs) are gaining popularity among high-income country (HIC) residency programs. While evidence demonstrates a benefit for the visiting residents, few studies have evaluated the impact of such rotations on the orthopaedic surgeons and trainees in LMICs. The purpose of this study was to further explore themes identified in a previous survey study regarding the local impact of visiting HIC resident rotations. Methods: Using a semistructured interview guide, LMIC surgeons and trainees who had hosted HIC orthopaedic residents within the previous 10 years were interviewed until thematic saturation was reached. Results: Twenty attending and resident orthopaedic surgeons from 8 LMICs were interviewed. Positive and negative effects of the visiting residents on clinical care, education, interpersonal relationships, and resource availability were identified. Seven recommendations for visiting resident rotations were highlighted, including a 1 to 2-month rotation length; visiting residents at the senior training level; site-specific prerotation orientation with an emphasis on resident attitudes, including the need for humility; creation of bidirectional opportunities; partnering with institutions with local training programs; and fostering mutually beneficial sustained relationships. Conclusions: This study explores the perspectives of those who host visiting residents, a viewpoint that is underrepresented in the literature. Future research regarding HIC orthopaedic resident rotations in LMICs should include the perspectives of local surgeons and trainees to strive for mutually beneficial experiences to further strengthen and sustain such academic partnerships.

JAAOS: Global Research and Reviews

The American Journal of Surgery

BACKGROUND Despite interest among North American orthopaedic residents to pursue rotations in res... more BACKGROUND Despite interest among North American orthopaedic residents to pursue rotations in resource-limited settings, little is known regarding resident motivations and impact on host surgeons. METHODS Surveys were distributed to North American orthopaedic surgeons and trainees who participated in international rotations during residency to assess motivations for participation and to orthopaedic surgeons at partnering low- and middle-income country (LMIC) institutions to assess impact of visiting trainees. RESULTS Responses were received from 136 North American resident rotators and 51 LMIC host surgeons and trainees. North American respondents were motivated by a desire to increase surgical capacity at the LMIC while host surgeons reported a greater impact from learning from residents than on surgical capacity. Negative aspects reported by hosts included selfishness, lack of reciprocity, racial discrimination, competition for surgical experience, and resource burdens. CONCLUSIONS The motivations and impact of orthopaedic resident rotations in LMICs need to be aligned. Host perceptions and bidirectional educational exchange should be incorporated into partnership guidelines.

East African Orthopaedic Journal, Apr 4, 2019

Background: Limb amputation, often from road trauma, is common in low-income countries. Providing... more Background: Limb amputation, often from road trauma, is common in low-income countries. Providing prosthetic devices for amputees is challenging and limited research exists regarding barriers to prosthesis provision. This study aims to elucidate the Prosthesis Provision Pathway (PPP) and identify barriers of prosthesis accessibility at the Muhimbili Orthopaedic Institute (MOI) in Dar es Salaam, Tanzania. Patients and Methods: At MOI, 18 healthcare providers, who included 4 orthopaedic technicians, 4 physical therapists, 4 orthopaedic surgeons, 4 junior doctors, and 2 hospital administrators were interviewed and blinded. Responses from semi-structured interviews were transcribed and common themes were identified. A process map diagramming the prosthesis provision pathway was created to highlight barriers and potential areas of improvement. Results: Six main themes emerged from the interviews: the first is that the prosthetics are expensive both for patients and MOI. Second, there are misperceptions of how prosthesis cost will be distributed. Third, there is inefficient communication between providers. Fourth, improved surgical education is needed to improve amputation outcomes. Fifth, amputees face psychosocial stigma, but prosthetics are becoming more accepted. Lastly, healthcare providers understand that trauma is the most common aetiology for amputation. Conclusions: Potential solutions to solving the prosthetic shortage will involve making prostheses more affordable, integrating the orthopaedic prosthesis workshop earlier in the provision process, improving surgical education and communication between providers, and working to prevent road trauma.

Prosthetics & Orthotics International

Journal of Orthopaedic Trauma, 2015

A dissertation submitted in (partial) fulfillment of the Requirements for the Degree ii CERTIFICA... more A dissertation submitted in (partial) fulfillment of the Requirements for the Degree ii CERTIFICATION The undersigned certifies that he has read and hereby recommends for acceptance by Muhimbili University of Health and Allied Sciences as dissertation entitled Early Outcome of Polytrauma Patient Attended at MOI and MNH Emergency Department in (Partial) fulfillment of requirements for the Degree MUHAS for his technical support. I am grateful also to Dr Mosha from the Department of Pathology for assistance in doing post-mortem. I like to convey my thanks to all academic members of staff in the Department of Orthopedic and Trauma MUHAS and MOI for their input during development, follow up analysis of this dissertation. I am grateful to my wife, Evarister S. Ndilila for her support, courage, commitment and taking good care of the family during my study period. I humbly thank almighty God for a good health throughout my study period. v DEDICATIONS This dissertation is dedicated to my bel...

Tanzania Journal of Health Research, 2011

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue... more Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage and is one of the leading complaints in emergency departments (EDs). Despite the important and the advantages of pain control, still patients do not receive appropriate attention. The objective of this study was to assess pain management among adult patients with fractures of long bones at Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. A descriptive Cross-sectional study design (Hospital based) was used. A total of 250 patients aged 18-60 years old with fractures of long bones were recruited from March to June 2008. Structured questionnaires and observation guide were used to collect data. Verbal rating scale was used, to determine the intensity of pain. The study shows that there is no documentation for pain assessment or reassessment at Emergency Department. Slightly above half (54%; 135/250) of patients were not given analgesics. The commonest analgesic given was ...

Tanzania Journal of Health Research

Background: Comminuted femoral shaft fractures are complex to treat because of increased risk of ... more Background: Comminuted femoral shaft fractures are complex to treat because of increased risk of limb length discrepancies and mal-rotation deformities. Currently the interlocking intramedullary nail using image intensifiers is a suggested treatment for comminuted femoral shaft fractures. This study aimed to evaluate the short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary SIGN nail without image intensifiers at Muhimbili Orthopaedic Institute (MOI) in Tanzania.Methods: A prospective hospital base study was conducted on patients with closed comminuted femoral shaft fractures admitted at MOI from March 2011 to February 2012. A total of 91 adult patients (18 to 84 years) were enrolled in the study. Of the total patients, 80 (88%) patients were male, 11 were lost to follow-up, and 80 patients completed follow-ups of 18 weeks post operatively. Structured questionnaires and checklist forms were used to collect information. Opera...

Tanzania Medical Journal, 2020

Background Total hip arthroplasty and hemiarthroplast are currently common procedures in our sett... more Background Total hip arthroplasty and hemiarthroplast are currently common procedures in our setting, Subluxation and periprosthetic facture of the femur has been reported. This can be linked to undersize and oversize of the prosthesis since most of these prosthetics are western standardized. This is partly because of lacking data of the size of the proximal femur. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint. Knowledge about the different diameters of the head, neck and length of femur is essential in orthopedic surgery and radiology and forensic medicine. These normative values are essential for plastic and reconstructive surgeons in their reconstruction and medical rehabilitation. However, the anatomical and anthropological statistical analysis of femoral anthropometry among different populations reveals a great variation for all human races. The present study aimed at determining morphometric measurements of proximal femur among ...