1. Purpose

The BHS International Development Committee (IDC) has been established to promote ethical, sustainable, and impactful international collaboration in the field of hip surgery. Its primary goal is to support the development of self-reliant surgical units in low- and middle-income countries (LMICs), through education, partnership, remote support, and improved access to high-quality arthroplasty care.

This initiative is grounded in the belief that total hip replacement (THR)—widely regarded as the “operation of the century” (The Lancet, 2007)—should be accessible globally. Yet, in many LMICs, access remains severely limited due to a lack of training, resources, and infrastructure. The IDC seeks to address this disparity through responsible, long-term collaboration.

2. Aims and Objectives

• Support the development of locally led, selfsustaining arthroplasty services in LMICs.
• Facilitate training, mentorship, and skills transfer to build surgical and perioperative capability.
• Promote remote participation in MDT discussions to support clinical decisionmaking and international peer support.
• Encourage ethically sound implant and equipment donation, in collaboration with industry and nongovernment organizations (NGOs)
• Maintain a clear focus on equity, sustainability, and respect for local context.
• Develop and share standards, toolkits, and guidance for international orthopaedic engagement.
• Encourage research and audit activity to support datadriven improvements in global arthroplasty care.
• Build partnerships with other relevant organisations (e.g., BSSH, WOGO, WOC Global Health).
• Promote multidisciplinary collaboration, including input from BHS Allied Healthcare Professionals (AHPs), to develop and share rehabilitation protocols tailored to resourcelimited settings.

3. Membership and Structure

• Chair: Appointed by the BHS Council; responsible for committee leadership and reporting to the BHS Executive.
• Executive member: Provide elected oversight of the co-opted committee pending formal ratification at BHS 26
• Committee Members: Up to 5 BHS members selected based on their commitment to and experience in international orthopaedics.
• Observers/Advisors: Representatives from relevant global surgery organisations or partner sites may be co-opted as needed.

Appointments are for a 3-year term[KG1] , renewable once with BHS Executive approval. Efforts will be made to ensure a diverse and representative committee.

4. Key Activities

• Maintain a register of BHS members engaged in international development work.
• Support the development of local MDT infrastructure, including guidance on virtual MDT participation and data-sharing protocols.
• Assist in implant sourcing and donation where needed, with full transparency and ethical oversight.
• Identify and build institutional partnerships with orthopaedic units in LMICs, following a 'twinning' model.
• Promote surgical fellowships and exchange programmes, enabling bilateral learning[KG2] .
• Contribute to academic outputs, including case reports, outcome studies, and education research.
• Advocate for increased global access to hip surgery through policy engagement and public awareness.
• Engage BHS Allied Healthcare Professionals (AHPs), including physiotherapists and occupational therapists, to assist in:
• Developing context-appropriate rehabilitation protocols for hip arthroplasty patients.
• Providing training and mentorship for local rehabilitation staff in LMICs.
• Supporting the creation of patient education materials suitable for varied literacy levels and cultural contexts.
• Recognise that many partner sites have limited or no exposure to elective orthopaedics and require foundational guidance in perioperative and postoperative care.

5. Meetings

• The committee will meet a minimum of three times per year[KG3] , with at least one in-person meeting at the BHS Annual Meeting.
• Virtual meetings will be used for flexibility and international inclusion.
• Subgroups may be formed to focus on specific areas (e.g., education, implant access, MDT support).
• A quorum for decision-making will be 50% of the membership[KG4] .

6. Communication and Reporting

• A committee update will be included in the BHS AGM and featured in the BHS newsletter.
• Activities, opportunities, and guidance will be shared through the BHS website and member communications.
• The Chair will provide regular updates to the BHS Executive Committee.

7. Governance and Review

• All committee activities will adhere to BHS ethical standards and global health principles, including patient safety, consent, and respect for local health systems.
• The Terms of Reference will be reviewed annually to ensure alignment with BHS strategy and global best practices.
• All overseas activities conducted under the BHS name must be pre-approved by the committee and the Executive Council.

8. References and Supporting Documents

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508–19.

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet Commission on Global Surgery. 2015.

Shelton C, Thou L, Channa R, Gollogly J. Total hip arthroplasty in a low-resource setting: 256 cases in Cambodia. Tropical Doctor.

BSSH Overseas Committee Guidelines

WOGO Mission & Ethics Statements

The Shelton et al. study provides valuable evidence that hip arthroplasty, when delivered with appropriate surgical support, can achieve successful outcomes even in resource-constrained environments. This supports the IDC’s commitment to enabling sustainable arthroplasty services in LMICs.