I. What is an artificial hip joint replacement?
An artificial joint is an artificial organ that is designed to save a joint that has lost its function, thereby relieving pain and improving function. Artificial hip prostheses have been designed according to the structural characteristics of the hip joint and are similar in function. Artificial hip joint replacement is to remove and repair the hip joint that has lost its function, and place a matching artificial joint to make it functional again.
Second, who and when do I need artificial hip replacement?
Osteoarthritis, rheumatoid arthritis, ischemic necrosis of the femoral head and ankylosing spondylitis are a group of common diseases that cause joint wasting, of which the incidence of rheumatoid arthritis is 0.3% and osteoarthritis is 3%. With the aging of society, the incidence of osteoarthritis is still increasing year by year. The hip joint is one of the main joints that are easily invaded. When the joint lesion is more serious, the joint surface is severely worn and damaged, and even deformation occurs, resulting in joint pain and limited function. When the hip joint has repeated pain and starts to prevent normal walking, or even limp, walking distance is gradually shortened, and sometimes the pain is produced or aggravated when going up and down the stairs or standing up from the chair, when these symptoms gradually affect daily life and work, conservative treatment such as oral anti-inflammatory and analgesic drugs are often ineffective, and artificial hip replacement may be needed to improve the symptoms. Its indications include advanced osteoarthritis, rheumatoid arthritis, ischemic necrosis of the femoral head, and ankylosing spondylitis. In addition, artificial hip replacement is also feasible to reconstruct joint function in elderly people with old fractures of the femoral neck, hip subluxation, dislocation, acetabular dysplasia combined with severe secondary osteoarthritis, and after removal of periarticular tumors (benign and malignant).
Artificial hip arthroplasty is to remove the worn and damaged joint surface and replace it with an artificial joint prosthesis to restore a normal and smooth joint surface. It not only relieves hip pain, but also greatly restores the function of the joint and greatly improves the quality of life. It has enabled some patients with severe destruction of advanced joints or long-term bed-ridden patients to regain their standing and walking functions through surgery. After more than 40 years of development, artificial hip joint replacement technology has been perfected and has become the most effective treatment for severe hip diseases, and is regarded as one of the most successful surgical procedures in the 20th century. As a mature treatment method, artificial hip replacement is very popular in Europe and the United States. In 1997 alone, the United States with a population of 260 million people performed 550,000 total hip and knee replacements, while China with a population of 1.2 billion people only performed 1,60,000 cases in 1999.
The reasons for this realistic gap are.
(1) Due to a serious lack of popularization of science, many patients do not know that the loss of joint function brought about by bone and joint disease can be completely treated by joint replacement, and what’s more, many of our primary care physicians, likewise, do not know the specific indications of this technology, i.e., what patients should choose joint replacement and when they should operate, which results in many delays and lost opportunities for treatment .
(2) Misunderstanding the effect of surgery, many patients refuse to go to the hospital, many people have a clear diagnosis, but when doctors and they talk about artificial joint replacement, they are always worried about the effect of treatment and refuse to operate, in addition to not understanding, the main thing is that they know or heard of some cases of poor treatment, often listen to patients say: “doctor, it’s not that I do not want to operate, we There XXX, our community or our unit XXX opened this surgery has been bad walking, I’m afraid”, the patient’s psychology is completely understandable, but they do not know that there is a surgical technique and surgical experience, the United States in 2004 the American Joint Institute of 80,000 cases of artificial joint survey report shows that 80% of the patients are those who operate every year Therefore, it is important to consider that a small number of inexperienced surgeons can cause surgical failure or poor results, which does not negate a mature traditional treatment technique. At least a specialist in joint replacement should be chosen.
(3) Affordability constraints, due to the domestic artificial joint in materials, manufacturing process, tool configuration and other reasons, resulting in the majority of clinical use of imported artificial joint materials, expensive, the general patient even if willing to operate, but also can not afford the huge cost of surgery.
Third, the artificial hip joint prosthesis fixed way, type and service life.
There are many types of artificial hip prosthesis, according to the way it is fixed, can be divided into cemented and non-cemented prosthesis. The former is generally used for the elderly, the latter is more suitable for young patients. The non-cemented joint press-fit biologically fixed prosthesis, the surface of the prosthesis is mostly titanium wire or hydroxyapatite coating, which helps the bone tissue to grow into and firmly bond with the prosthesis to obtain long-term fixation. The joint surfaces consist of a metal femoral head and a polyethylene plastic acetabular liner. Since polyethylene plastic is prone to wear and tear, the resulting polyethylene particles can cause resorption and dissolution of the bone tissue around the prosthesis, which can lead to loosening and failure of the prosthesis, metal-to-metal and ceramic-to-ceramic joint surfaces have been designed in recent years to reduce wear and tear and reduce the incidence of aseptic loosening of the prosthesis. Almost all patients ask: How long will the artificial joint last? Is it true that the more expensive the prosthesis, the longer it will last? No one knows exactly how long a joint prosthesis will last, but most doctors tell their patients that the life expectancy of a hip prosthesis is 10 to 15 years. Generally speaking, the life span of a prosthesis is not based on the material alone, but also depends on the installation technique of the doctor and the degree of care used by the patient.
Fourth, complications and hip pain causes analysis.
As more and more artificial hip surgery is carried out, complications have become a major factor limiting its efficacy. These complications include: dislocation, infection, vascular nerve injury, venous embolism, periprosthetic fracture and aseptic loosening. Infection is the most devastating of these, but fortunately its incidence is low. Aseptic loosening of the joint prosthesis is the most common long-term complication and the main cause of artificial joint failure. When the hip prosthesis loosens, patients often experience hip pain, instability and hip weakness, and often require an artificial hip revision, i.e., reoperation after the failure of the first arthroplasty. Compared to the initial hip replacement, revision surgery is more difficult and complex. The chances of success are also lower. Some patients may experience hip pain after surgery. Hip pain within 3 months after surgery may be related to tissue trauma and edema, infection and inflammation, tight fitting of the artificial joint prosthesis, and maladjustment of the joint. Late hip pain should be considered as aseptic loosening of the prosthesis and late deep infection. The former pain is characterized by pain plus sawing after activity, while the latter is resting pain, i.e. pain is still felt at rest. The location of the pain is also very relevant, generally the pain in the groin area is mostly related to the acetabular side of the lesion; while the thigh pain is mostly related to the femoral side of the lesion. The pain in a few patients after surgery is manifested as thigh pain, and the common reason may be related to the presence of micromovement if the distal femoral prosthesis is too tight or too small, and the cause of about one-third of thigh pain is unknown.
V. Postoperative rehabilitation and precautions: Due to the above reasons, postoperative functional rehabilitation exercises and correct use of the joint are particularly important. The best time for functional exercise is within six months after surgery. Generally, muscle strength and joint activity exercises can be carried out under the guidance of doctors in 2-3 days after surgery, and the wound stitches can be removed in 10-14 days after surgery, and the patient can be discharged from the hospital, and functional exercises of walking on crutches and going up and down stairs can be carried out according to the program directed by doctors after discharge. Generally, hip flexion should not be greater than 90 degrees, and avoid cross-legged movements of the two lower limbs; do not bend and flex the hip to pick up things or sit on a low toilet; when walking up or down stairs or standing up from the seat, it is better to use hand-assisted support to reduce the damage of these movements to the joint prosthesis. In addition, we also hope that the patient can maintain an ideal weight. If you experience increased wound swelling and pain, discharge, hear abnormal sounds in the joint or have difficulty walking due to joint injury, you should return to the hospital immediately for examination. When there is a dental disease that needs to be treated by a dentist, any wound on the skin that is inflamed or any other surgery, it is advisable to apply antibiotics to prevent bacteria from entering the joint and causing serious infection.
Sixth, small incision minimally invasive artificial hip joint replacement technology.
Artificial hip replacement has a history of more than 40 years. In recent years, with the continuous updating and improvement of the concept of artificial joint replacement and the continuous improvement of artificial joint materials and techniques, the service life of artificial hip replacement has developed to a more satisfactory level, and artificial hip replacement has thus become one of the most mature and reliable surgical techniques. However, conventional artificial hip arthroplasty for the elderly still carries a high surgical risk, and the functional recovery of the limb after surgery is slow. How to ensure the safety of the perioperative period, reduce surgical trauma and blood transfusion, and resume daily work and life as soon as possible has become a key aspect to further improve the artificial hip replacement. In recent years, we have adopted the small incision minimally invasive replacement technique of artificial hip joint, which is a new technology and method with great practical value. It is mainly used to achieve the purpose of less trauma and less bleeding through controlled intraoperative decompression, improvement of surgical anatomical access, specially tailored mounting tools and delicate operation during surgery. Its main methods are single-incision and double-incision techniques, the former including both anterior and posterior approaches; the latter often requires operation under the supervision of X-ray fluoroscopy machine.
Compared with traditional artificial hip joint replacement surgery, it has the following advantages.
1. Small incision, less trauma and less bleeding. The principle of minimally invasive replacement is to achieve the best treatment effect with the least trauma. It reduces the stripping and destruction of soft tissues such as muscles and tendons as much as possible to reduce the pain of patients during and after surgery. The average incision of artificial hip replacement is 16-22 cm long, while the small incision is about 6-8 cm; the former has more bleeding, mostly above 800 ml, and most of them need blood transfusion, while the latter has an average bleeding of less than 400 ml and generally does not need blood transfusion, thus also avoiding the problem of infection brought by blood transfusion itself.
2.Faster recovery of joint function. In general, artificial hip replacement requires 3~4 weeks of hospitalization, followed by 3~4 months of rehabilitation; according to a study by Rush University, the average hospitalization time for patients with small incision minimally invasive replacement is 3~5 days, and the rehabilitation time is 1-2 months, while a study in the United States shows that with double incision minimally invasive technology, 85% of patients can be discharged home on the first day after surgery, and 15% of patients are discharged the next day This significantly shortens the time required for postoperative joint function recovery.
3. Fewer perioperative complications and reduced surgical risks. Due to the surgical trauma and the different degrees of diseases and degeneration of the organs of the elderly, such as hypertension, diabetes, cerebral vascular sclerosis, coronary heart disease, arrhythmia and pulmonary decompensation, the conventional artificial hip replacement for the elderly still has a greater surgical risk, especially the more dangerous life-threatening complications, such as myocardial infarction, cerebral infarction and pulmonary infarction. cerebral infarction and pulmonary infarction. Small incision replacement is less invasive, thus reducing such complications caused by surgical injuries.
4. Light pain, beautiful incision, and high patient satisfaction. Surgical pain and the size of the incision have always been a concern for patients and their families. Since small incisions reduce the stripping and destruction of soft tissues such as muscles and tendons, postoperative pain is lighter; at the same time, small incision scars and aesthetic appearance are also more acceptable to patients.
5. Reduce the economic burden of patients. Because of the shortened hospitalization time and reduced or no blood transfusion, the economic burden of patients is reduced.