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

Patients typically experience severe knee pain and difficulty walking or standing for months by the time our medical partner will perform a total knee replacement (TKR). A TKR treats knees that are severely damaged and therefore not amenable to any other form of treatment.

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

Patients may not be able to walk, and physical activity is extremely restricted, making any movement painful. This prevents patients from being able to carry out daily life.

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

Cambodia's population is about 16 million people, and the median age is only 24.2 years. While some patients' arthritic joints are caused by old age, younger patients may also develop arthritic joints from congenital, infectious, and traumatic causes. Traumatic causes include motorbike accidents, which are common. Motorbikes are the main form of transportation in Cambodia, but traffic laws are rarely followed and weakly enforced. Often, patients injured in motorbike accidents cannot afford to seek proper treatment in local clinics or hospitals. They visit Khmer traditional healers or simply take pain medications. Their injuries never heal.

What does the treatment process look like?

During a knee replacement procedure, surgeons remove the damaged cartilage and bone from the ends of the femur and tibia. The removed portions are replaced with metal components that recreate the surface of the joint. The under-surface of the patella (kneecap) is cut, and a plastic button is placed. A medical-grade plastic spacer is then inserted between the metal components to create a smooth gliding surface.

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

The patient will be able to walk without pain, improving his or her quality of life.

What potential side effects or risks come with this treatment?

There are very few risks posed by a TKR. Blood clots are possible, as they are with most orthopedic surgeries. However, common preventative measures have reduced their risk, and now less than 2% of patients develop them. Osteolysis, which occurs when fragments are released from the knee implant into the body and cause inflammation, is possible but uncommon. Scar tissue or other complications can sometimes affect motion in the knee, but these can be resolved with special exercises or physical therapy.

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

No other hospital or organization in Cambodia is currently doing TKRs, and there are many people with painful, arthritic knees who cannot live their lives comfortably. CSC is the only center that provides this procedure free of charge. Patients travel to CSC by bus, taxi, or motorbike.

What are the alternatives to this treatment?

A patient may undergo a knee fusion at another facility. This procedure will reduce his or her pain, but will leave the patient with a stiff knee that does not bend.