title: Global health and orthopaedic surgery-A call for international morbidity and mortality conferences.
abstract: BACKGROUND
  There is a large discrepancy between supply and demand of surgical services in developing countries. This inequality holds true in orthopaedic surgery and the delivery of musculoskeletal care. Intertwined amongst the decision to perform surgical procedures in the developing world are the ethics of doing so - just because one is capable of performing a procedure, should it be done?
  
  
  METHODS
  A 31 year-old female with end-stage joint destruction underwent a left total hip replacement by a foreign orthopaedic team in Tanzania. She had a favorable outcome for 8 months, but is now diagnosed with tuberculosis and a deep space infection in her prosthetic left hip - an unsolvable problem in the developing world.
  
  
  CONCLUSIONS
  This case demonstrates the ethical challenges that can be created from performing surgical procedures in the developing world without concomitant access to appropriate patient follow-up or resources for treating post-operative complications. While the current system is inadequate to manage the burden of disease, these inadequacies may be exacerbated at times by post-operative complications resulting from well-intentioned surgical missions.
  
  
  CONCLUSIONS
  This case illustrates many difficulties in caring for individuals in the developing world, raising several questions: (1) How can complications be prevented in the future? (2) What are possible ways of managing complications with resources at hand once it occurs? (3) What resources are needed to minimize patient? Ideally an international forum can help provide descriptions of issues and problems that are encountered so as to increase awareness and identify potential solutions.
authors.affiliation: Adult Hip and Knee Reconstruction, Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104, USA. Electronic address: neilshethmd@gmail.com.
authors.forename: Neil P
authors.initials: NP
authors.lastname: Sheth
authors.affiliation: Division of Orthopaedic Trauma, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Donegan
authors.affiliation: OrthoColorado Golden, CO 80401, USA.
authors.forename: Jared R H
authors.initials: JR
authors.lastname: Foran
authors.affiliation: Johns Hopkins University, Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sugarman
keywords: Bioethics; Global health; Orthopaedic surgery