​What kinds of symptoms do patients experience before receiving treatment?

Patients experience pain in the hip or groin, are unable to stand or put weight on the leg of the injured hip.

​What is the impact on patients’ lives of living with these conditions?

Patients with hip fractures have limited mobility and are often in constant pain.

What cultural or regional factors affect the treatment of these conditions?

Many Cambodians use motorbikes as their main form of transportation. Because of weak traffic laws, motorbike accidents are common. Injured individuals who cannot afford treatment often self-medicate or rely on Khmer traditional healers. This often delays proper care and patients may suffer great pain prior to surgery. Fractures never heal, and patients live with the pain. Steroids are a common pain treatment in Cambodia. No prescription is required. Individuals who do intense physical labor take steroids regularly, which restricts blood flow to the joints. This causes bone tissue death and tiny bone breaks, making bones more susceptible to breaks and fractures. Fractures are associated with significant morbidity, mortality, loss of independence, and financial burden.

What does the treatment process look like?

A hip hemiarthroplasty is a "half a hip replacement" and is reserved for patients who fracture the hip and where fixation is either not possible or not provide reliable results - whereas half a hip replacement is the reliable procedure. The head of the damaged thighbone (femur) is replaced with an implant that stabilizes the femur while restoring function to the hip. When the head of the femur is removed, the inside of the femur is hollowed out, and a metal stem is placed snugly inside the femur.

What is the impact of this treatment on the patient’s life?

Hemiarthroplasties are often reserved for elderly patients who break their hip but where a total hip replacement may not be completely necessary. These patients get pain relief and restored mobility. Without surgery, many patients may experience further complications like blood clots from immobility.

What potential side effects or risks come with this treatment?

Patients may experience prosthesis-related complications, including fracture of the bones around the implant, dislocation, infection, aseptic loosening, and wear on the socket of the hip bone. These complications can lead to increased morbidity, mortality, and cost.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

Children's Surgical Centre was one of the first hospitals to offer hip replacement surgery and continues to offer the latest techniques for little or no cost to Cambodians who cannot afford it. Typically patients travel two to eight hours over rough or dirt roads, often in a tuk-tuk. They are referred by provincial hospitals or by neighbors and relatives.

What are the alternatives to this treatment?

There are other surgical alternatives, and much depends on the type of fracture, the health, and the age of the patient. Many poor Cambodians seek help from traditional Khmer healers with a delayed presentation to proper care. Some fractured hips may heal on their own, but it involves complete bed rest and joint immobilization for three to four months. This creates other potential complications, especially for the elderly, and is almost impossible in Cambodian culture and lifestyle.