In response to the many questions from patients in the clinic and online about artificial knee arthroplasty, here is a unified answer, I hope it will be helpful to you, welcome you to leave a message to discuss or ask questions
What kind of patients are suitable for artificial knee replacement?
Artificial knee arthroplasty is suitable for patients with severe osteoarthritis, ankylosing spondylitis, rheumatoid arthritis and other diseases that cause knee joint destruction, knee internal and external rotation or flexion contracture deformity, and other knee joint pain, instability, deformity, and severe limitation of daily life and activities, which are not effective after conservative treatment or are not effective. Patients with active knee infections, tuberculosis, and severe muscle and nerve dysfunction are not suitable for knee replacement.
At what age is an artificial knee joint replacement suitable?
The optimal age for artificial knee replacement is 60-70 years old. With the continuous development of artificial joint technology and improved surgical techniques, as well as the increase in average life expectancy, the age range for artificial knee replacement has tended to expand. Age is not the primary consideration for knee replacement, but rather the decision is based on the patient’s health and symptoms, and the degree of knee pathology.
What is the outcome of knee replacement?
Total knee arthroplasty is a very effective procedure, with a 98% follow-up rate 10-15 years after surgery, relieving patients of pain and other symptoms, restoring limb function and self-care, and improving quality of life.
How long does an artificial joint last?
Artificial joints can wear out. However, the strength and wear resistance of artificial knee joint materials are so strong that they can generally meet the needs of patients for more than 15 years, with good quality joints lasting longer. The service life of an artificial joint is also dependent on many factors, such as the amount of exercise the patient performs, the choice of artificial prosthesis, the surgeon’s surgical technique, and his or her own condition. In particular, the material and process of the prosthesis is also relevant, and it is recommended to use imported products or joint venture products.
How to choose the artificial joint?
Different types of prosthesis can be selected according to the patient’s age, expectations of the surgery, economic situation, amount of sports, etc., as well as the experience and skill level of the joint surgeon. Smaller hospitals generally use domestic prostheses, while larger hospitals use more imported products or joint venture products.
What are the complications and risks of artificial knee replacement?
Complications can occur with any surgery, and it is important to assess the risks and complication rates for your condition, and to manage and prevent them accordingly. Knee replacement is a moderate orthopedic procedure and there are a variety of complications that can occur including
1. Infection: This includes skin infection and deep wound infection. The prevention methods are preoperative, intraoperative and postoperative application of antimicrobial agents and aseptic operation. After surgery, there will be 1~2 drains in the wound to draw out the bleeding in the wound to prevent the wound from accumulating blood infection, which is usually placed for 24~48 hours and then removed.
2, thrombosis: lower limb thrombosis is more common, and the vast majority can be cured. Prevention methods are application of anticoagulants, application of intravenous pumps, muscle contraction exercises, etc. Lower limb elevation on a soft cushion to reduce pain and help lower limb blood flow back to prevent lower limb thrombosis and swelling.
3, neurovascular injury: seen in cases with unclear anatomical structure or severe deformity.
4, fracture: intraoperative fractures are mostly seen in patients with severe osteoporosis, and postoperative fractures are mostly caused by trauma.
5.Prosthesis loosening: mostly occurs in the distant postoperative period after joint replacement. Pain or poor joint function after prosthesis loosening requires re-operation.
6. Heart, lung and brain complications: less common, but can be life-threatening in severe cases.
How to choose anesthesia for artificial knee joint replacement?
Lumbar epidural anesthesia and general anesthesia are available: patients with lumbar anesthesia are awake and recover quickly, but they are slightly tired with the same posture during surgery; elderly patients, patients with lumbar hyperplasia who have difficulty with lumbar anesthesia and patients who request it themselves can choose general anesthesia, sleep during surgery and wake up after sleep.
How is the surgery done?
The surgery is a “surface replacement” in which the damaged cartilage, the hyperplastic bone, the synovial membrane and a small part of the sclerotic bone cortex are removed and a metal prosthesis is implanted to wrap the femur and tibia, with a polyethylene pad in the middle; this relieves pain, restores the force line of the knee joint and increases the range of motion in flexion and extension.
Is the artificial knee joint replacement surgery major? How long does the surgery take?
Knee replacement is one of the larger surgical procedures in joint surgery and has become more common overseas. The surgery alone takes about an hour or so, plus anesthesia and sterilization time, usually about 2 hours.
Is the pain after the artificial knee replacement severe?
Pain will be more pronounced during the first day after surgery. The surgeon will use analgesic medication or an intravenous pain pump for pain relief. The pain will gradually decrease after 24 hours. There will be some increased pain when you start functional exercises, and you can take oral pain medication, but it will decrease quickly.
How long will I have to stay in the hospital for the knee replacement?
After 1-2 days of necessary preoperative examination and laboratory tests, if there is no contraindication to surgery, the patient will be operated.
Can patients with high blood pressure, heart disease and diabetes have knee replacements?
Generally speaking, patients with high blood pressure, heart disease and diabetes should be cautious about having a knee replacement. Patients with hypertension can have a knee replacement if they can control their blood pressure with medication and do not have other complications caused by hypertension. Patients with heart disease who have good cardiac function and no serious arrhythmias or angina pectoris may also be eligible for joint replacement. Diabetic patients can have knee replacement surgery if they have normal blood sugar control and no serious complications from diabetes. Patients with diabetes have a higher risk of postoperative infection, so long-term medication should be used to control blood sugar in the normal range after surgery. Patients with these diseases need a thorough preoperative examination and a comprehensive evaluation and treatment by the relevant department before surgery can be considered.
Is it possible to have bilateral knee replacements at one time?
Yes. Many patients with osteoarthritis have bilateral disease, so it is possible to have both knees replaced at the same time in a single hospitalization, which can reduce pain, cost and the number of hospitalizations. The decision to operate on both knees at the same time should be based on the physician’s evaluation and the patient’s own choice.
Can the artificial knee be replaced after it has worn out or loosened?
Yes. The incidence of infection or loosening of the artificial knee is very low, but once the artificial knee becomes infected or loosened, “revision surgery” will be required. There are special knee prostheses and surgical instruments available. Revision surgery is relatively complex and may involve bone grafting, changing the type of joint prosthesis, or using a special prosthesis. After revision surgery, the vast majority of patients will have a satisfactory outcome.
How to prepare before surgery?
Psychological preparation: understand the operation to reduce the patient’s fear of surgery; quit smoking and alcohol 2 weeks before surgery; practice bed urination and defecation to prevent unaccustomed bed after surgery; keep the body clean and treat the infection foci existing such as cold and pneumonia; treat other diseases such as combined hypertension, heart disease and diabetes; preoperative instruction: firstly, the static contraction exercises of the quadriceps muscle of the affected limb and the active movement of the ankle joint should be strengthened. The quadriceps should be required to hold each contraction for 10 seconds, and every 10 times for 1 group, completing 5 to 10 groups per day. The patient sits on the bed and performs straight leg raising and ankle flexion and extension exercises with resistance, the number of times can be determined according to the patient’s condition and repeated 2 to 3 times a day.
What are the considerations for diet after surgery?
You can eat after about 6 hours after surgery, gradually change from liquid and semi-liquid to normal diet; insist on diabetic diet for diabetic patients, low salt and low fat diet for hypertensive and hyperlipidemic patients; quit smoking and alcohol 2 weeks before surgery; increase protein, vitamins and other nutritious diet appropriately; eat more easily digestible food, vegetables and fruits (such as bananas) to increase fiber and prevent constipation (and sit up more and reduce lying down time); change The misconception that “you can’t eat seafood and fish after surgery”, eating more fish can increase protein well.
How to do functional exercise after surgery?
1.1st week after surgery
Start isometric muscle contraction and dorsal foot extension and flexion activities 1-2 days after surgery. After the drainage tube is removed on the 2nd day after surgery, start to practice straight leg raising, and put the healthy foot under the affected limb to help raise the affected limb. The patient sits on the bed and the affected limb does the straight leg raising exercise, not requiring a lifting height, but a lag time of about 10 seconds; does the dorsiflexion exercise of the affected ankle joint, keeping the joint at 90°, and does the encircling exercise of the joint repeated 15 times, completing 2 to 3 times a day; applies the knee exercise machine ( CPM machine) to give passive exercise of the affected limb in a painless state, twice a day, and try to make the knee joint flexion reach or exceed 90° within 1 week.
2. The 2nd week after surgery
Make the affected knee painless, from the beginning of the joint movement, a small range of rhythmic back and forth to loosen the joint; further strengthen the straight leg raising movement of the affected limb; encourage the patient to get out of bed, with the help of crutches, walkers, first practice standing, at this time the center of gravity on the healthy side, the affected side is not weighted touch the ground, and then the center of gravity gradually transition to the affected side.
3.The 3rd week after surgery
Continue the active straight leg raising exercise to consolidate the previous training effect, restore the weight-bearing ability of the affected limb, strengthen the walking gait training, train the patient’s balance ability, and further improve the range of motion of the joint. In addition to bending knee functional training, attention must also be paid to functional training of knee extension, such as sitting leg press, etc.
The amount of training should be small to large and progressive, so as not to cause discomfort in the affected knee.
How to continue rehabilitation after discharge?
After discharge from the hospital, continue active straight leg raising and resistance exercises to increase muscle strength; knee extension and knee flexion exercises to increase the range of motion of the joint; gradually reduce the use of crutches and walkers, and you can usually walk independently after 2-3 months.
Daily precautions after knee arthroplasty?
1.Appropriate rest and exercise Progressively increase your activity, avoid too much strain, have the right amount of rest after exercise, and let the joint relax as much as possible in a normal posture.
2. Maintain an ideal weight to reduce the burden on the knee joint.
3. Avoid overloading the knee joint in daily activities to reduce the chance of joint wear and tear. For example, use a cart instead of carrying heavy things, and use handrails to go up and down stairs.
4.After knee surgery, please avoid the following movements: squatting, climbing, running, lifting heavy objects and walking long distances.
5. Observe the activity restrictions given by your physician until your next follow-up appointment.
6.Six months after surgery, you can swim, ride a bicycle and return to normal life.
7.If you have the following conditions, you should follow up immediately: when the wound is inflamed and there is discharge; when the pain is increased; when the knee joint is injured and causes difficulty in walking.
8. It is normal to take a film every 1-2 years after surgery to keep the information and review for comparison use.