Access to total joint arthroplasty (TJA) remains profoundly limited in low- and middle-income countries despite the growing global burden of end-stage degenerative joint disease. Although international orthopaedic outreach initiatives have expanded surgical access, adult reconstructive surgery has traditionally been underrepresented because of implant dependency, infrastructure requirements, and logistical complexity. This review describes a systems-based framework for delivering high-volume total hip and knee arthroplasty in a resource-limited environment through long-term international collaboration. Drawing on experience from the Gift of Disability Alleviation (GODA) in partnership with the Indus Hospital and Health Network in Pakistan, the model emphasizes year-round operational planning, preoperative imaging and templating, implant forecasting, international shipping coordination, operating room efficiency, multidisciplinary perioperative pathways, and integrated education. Annual surgical missions routinely deliver over 250 primary total joint arthroplasties within a six-day operative period using a limited number of surgeons. By prioritizing reproducible infrastructure over episodic intervention, this framework illustrates a structured framework for delivery of high-volume arthroplasty in underserved settings.
Siddiqi et al. (2026) studied this question.