In the course of your life, you have learned the concept of force modulation. Through a process of trial and error, you have learned how hard to close a car door, how gently to open a sugar packet, how carefully to hammer in a nail, and how cautiously to pass a thread through the eye of a needle. It takes practice, practice you sometimes don’t even realize you’re doing. But anyone who has successfully obtained toothpaste from a tube knows what I’m talking about.
In orthopedics, we learn the same concept. Through a rigorous and well-governed training process, we learn how hard you can pound a hip stem into a femur, or how tightly you can turn a screw into bone. Sometimes - and this is a universal truth - we learn things the hard way. We learn to do it right by doing it wrong. But learn it, we do.
But imagine if you suddenly found yourself in a world where those rules of force modulation were suddenly inapplicable. You push a car door shut - and it barely moves. You go to open a bag of salt & vinegar potato chips, and it doesn’t open. So you pull as hard as you can AND IT STILL DOESN’T OPEN. Wait... what?
This is joint replacement surgery in Ghana. The bone we have learned to handle so carefully in the States is as hard as granite here. This is a result of genetics, and a pathological issue known as osteonecrosis - “bone death.” People with the sickle cell trait have a predilection to clotting crises, and this results in abnormally hard bone. And in some of these Ghanaian patients, the bone is literally like stone. We deplete batteries and wear down metal saw blades just trying to cut through their bones.
So the usual rules no longer apply. We have had to re-educate ourselves with respect to the amount of force we have to apply to our tools. (And - let’s be honest - educating orthopedic surgeons is no picnic the first time around, never mind the second.)
Today was the second of four surgical days. So far we have replaced 45 joints: 38 hips and 7 knees. We continue to see cases of a complexity that is almost never seen in the US. And, from this experience, we continue to learn how best to provide care for these patients.
Thank you, as always, for your attention and support.