Developing a sustainable hip service in Cambodia.

OBJECTIVE: Initial report on establishment of a hip service in Phnom Penh, Cambodia at Children's Surgical Centre. We describe indications for total hip replacement (THR) and initial results. METHODS: A database was established to collect data and track patients for follow up. Initial data collected included; diagnosis, implant used, post-operative complications. As the service developed, pre- and postoperative Harris hip scores were included. RESULTS: High rate of avascular necrosis (AVN) as the initial diagnosis. Five years post initiation of the hip service, 95 patients have received 116 THRs; including 10 revisions, 12 bilateral procedures. Complications/failures requiring revision involved four prosthetic femoral neck fractures, two aseptic acetabular component, two late infections, one instability. One failure, a periprosthetic acetabular fracture, required removal of all prosthetics. Complications not requiring revision, included three post-op foot drops, three superficial wound infections, one Vancouver B1 periprosthetic femur fracture. Average age was 41. Overall implant survival is 85% at three years. DISCUSSION: AVN was the most common indication for THR: many patients had a history of hip trauma, and/or prolonged steroids from traditional healers for pain. Problems with specific implants were addressed by the company. A different stem is now routinely used, no further fractures have been reported. Acetabular loosening, thought to be due to poor technique, has been addressed by focused training. Infection rate is monitored, and microbiology resources are improving. CONCLUSION: Developing an affordable hip arthroplasty service in a country like Cambodia is challenging. Developing a local registry has helped to identify complications and modify techniques.

Combining continuing education with expert consultation via telemedicine in Cambodia.

Telemedicine has the potential to increase access to both clinical consultation and continuing medical education in Cambodia. We present a Cambodian surgical centre's experience with a collaboration in which complicated orthopaedic cases were presented to a panel of consultants using free online videoconferencing software, providing a combined opportunity for both continuing education and the enhancement of patient care. Effects of the case conference on patient care were examined via a retrospective review and clinician perspectives were elicited via a qualitative survey. The case conference altered patient care in 69% of cases. All Cambodian staff reported learning from the conference and 78% reported changes in their care for patients not presented at the conference. Real-time videoconferencing between consultants in the developed world and physicians in a developing country may be an effective, low-cost and easily replicable means of combining direct benefits to patient care with continuing medical education.

Large Osteochondral Fracture in a Patient with Bilateral Bicondylar Osteochondritis Dissecans and Spondyloepiphyseal Dysplasia Tarda.

We report a case of a large osteochondral fracture in a patient with bicondylar, bilateral osteochondritis dissecans and spondyloepiphyseal dysplasia tarda.