Moderator: Why do some people undergo artificial joint replacement and what is the purpose?
Professor: The purpose of artificial joint replacement is to solve two problems. The first is to solve the pain, and the second is to restore function. As people age, their joints and organs age. When joints age, especially weight-bearing joints such as knees and hips, cartilage metamorphosis occurs and deformation occurs, leading to pain. When a person is intolerant to pain, it affects function. Some people cannot put on their own shoes and socks because of poor function, and have difficulty going up and down stairs.
Moderator: Some elderly people say that aging joints are a geriatric disease and that they are naturally inflexible in old age, so if they have pain, they sit for a while longer and prefer to endure it rather than have surgery. To what extent is the pain or function affected that surgery is necessary?
Professor: When to operate depends on the patient’s own feelings, because each person has different requirements for quality of life. However, with the popularity of artificial joints and the change in living conditions, artificial joints are becoming more and more acceptable to the elderly. Artificial joints were originally introduced from abroad. Hip joints have been in use for half a century, and knee joints have been in use for 30 or 40 years. With industrial development and technological advances, artificial joint replacements have been extremely successful. Developed countries do the most of this type of surgery. Each year, 1.5 to 1.6 million people around the world have their joints replaced, with about 60 percent in developed countries such as Europe and the United States. Last year, it is said that nearly 200,000 joints were clinically used in China.
Moderator: Why are more artificial joints replaced in developed countries?
Professor: People’s perception is different. The social insurance in developed countries is good. People’s life philosophy is also different. Europeans and Americans believe that I have to have a good quality of body to live one day, and I can do whatever I want when my joints don’t hurt.
In the past, Chinese people did not recognize this technology. Many elderly people think that if they are 70 or 80 years old, they should bear the pain. But in the past few years, this concept is gradually changing. One of the reasons for this is that our life has become faster and we are all busy. I have elderly people in my family, and I am too busy to take care of them. If an elderly person is in too much pain to walk, they can hire a nanny at most. But for the elderly, their greatest happiness is not to have someone to wait on them, but to be able to take care of themselves. It is not happy to lie in bed and wait for someone to take care of them. On the other hand, joint pains can’t walk, and physical problems can occur. Diabetes comes out, you become obese, your blood pressure is high. This is the time to consider joint replacement.
”Pain can not walk 500 meters, to surgery.”
Moderator: The second indication for surgery, is it related to pain?
Professor: Yes. People have a particularly low tolerance for pain. If the pain is really unbearable, surgery should be considered. In the case of the knee, for example, the actual pain is measured by the ability to walk. If the person can’t walk 500 meters, it means that he is in more pain. It also means that the person can’t get out of the house and has to stay at home.
Moderator: This means that his or her quality of life has decreased?
Professor: Yes. No matter young or old, if one stays in the house all day, something is going to go wrong. First of all, brain problems, sitting all day watching TV, looking up at the ceiling, looking down at the floor, and no one to talk, the brain will not work. Second, long-term stay in the house, physical fitness will decline, and do not know what is happening outside, both physiological and psychological effects. Therefore, we take 500 meters as a limit. If one can walk 500 meters, it means that there is still some ability to walk and immediate surgery is not recommended.
On this basis, combined with the age, if you need to do it, do it, if you don’t need to do it, don’t do it, and never do it early if you can do it late. In my opinion, life should be divided into three parts. The first life self-care. Second to work and study and be able to stand on your own feet. The third is leisure and entertainment. If you are less than 65 years old but can no longer take care of yourself or go out to work or study, you will become a burden to others and should consider joint replacement. However, some young people have their joints replaced because they want to have recreation and dance and travel. That is not possible. After all, artificial joints are fake things, and if something goes wrong, it is a big deal. For these people, I would advise them to think deeply and carefully.
”A single joint replacement costs about 30,000.”
Moderator: What are the requirements for a knee or hip joint prosthesis used in a hospital? What is the approximate cost?
Professor: The prostheses we use are all products that have been tendered by the Beijing Municipal Medical Insurance, the quality is in line with national regulations, and the price varies up and down. The cost of artificial joint replacement varies from doctor to doctor and from hospital to hospital. It is related to the thinking of the surgeon. It is generally controlled at 25,000 yuan for a prosthesis and up to about 30,000 yuan. According to Beijing’s health insurance rules for joint replacement, no matter what material the prosthesis is replaced with, the patient can only be reimbursed 9,000 yuan, no matter how much money he or she has spent. Out-of-towners are reimbursed on a percentage basis.
Moderator: How do you choose for your patients?
Professor: My own principle is to choose the prosthesis according to the patient’s family status and occupation. If the patient is a rural medical insurance self-pay, I usually control a prosthesis about 25,000 yuan, a little higher in more than 30,000. If the patient is a Beijing medical insurance or medical reimbursement ratio of patients, the family economic conditions are better, choose a high-flexion knee prosthesis, more than 30,000 yuan. The surgical results are the same for both.
”According to the age and economic conditions, choose the prosthesis”
Moderator: You have likened yourself to an assembler. In what ways does this “fitter” affect the surgery for artificial joint replacement?
Professor: First of all, the number of operations. If you do this all day long, you will become skilled. Second, today’s artificial joints are made by numerous companies, just like car manufacturers, and there are different brands such as Mercedes-Benz, BMW, and Bluebird. Different companies have different operating systems, which are reflected in how much bone should be cut and how much should be inserted in a joint replacement. I basically choose only two companies’ prostheses, and I am very familiar with them, so I know exactly what to do in each process. And these two prostheses basically meet the needs of most patients.
Again, the surgeon has to choose a prosthesis that fits the patient. The most expensive one is not necessarily the best, but the one that fits you is the best. In the knee joint, there is a rotating meniscus and a fixed meniscus. For younger patients, I do a rotating meniscus, which cuts the bone less, has a higher degree of wear, and the life of the prosthesis can be longer. For younger patients, I would recommend a better prosthesis, at least a ceramic-tipped one, which is wear-resistant. But the elderly do not need to choose expensive ones, they are less active and do not show value after installation.
Moderator: The decision to choose the prosthesis, the doctor or the patient?
Professor: I have a point of view, the patient comes, if the doctor said there are 30,000, 40,000, 50,000 different value of the prosthesis, let the patient choose one. Such a doctor is not a professional doctor. It should be the doctor who decides to give the patient a prosthesis. Before each surgery, I explain to the patient why I gave you this surgery and chose this prosthesis. Many people have money and say how can you fit me with such a cheap one. I explain, “This prosthesis is enough for you, why do you have to spend so much money. With this money, go travel, how good.
Moderator: You just talked about the factors that can affect the results of surgery in the long term, one is infection, and another is loosening.
Professor: In addition to infection, loosening, and trauma. Usually there is no problem within one or two years after the surgery, it is three or five years later. Infections of hematogenous origin, most of them are caused by diabetes and urinary tract infections in the elderly. Traumatic injuries are mainly falls and fractures.
Moderator: What are the main post-operative complications? Is there a high risk?
Professor: There are various surgical complications. There are many complications during surgery, including anesthesia accidents, nerve damage, and dislocation, which are possible. The chances of these occurring when we do surgery are very low, but they are not 100% avoidable. The most important thing to ensure a successful surgery is anesthesia. When it is well controlled, the surgery is easier. The next thing is to have good control of the operation time. The longer the operation time, the longer the anesthesia, the more bleeding, the greater the chance of an accident. This is something that goes hand in hand.
Surgical risk and surgical danger are two concepts. Surgery has to assess the patient’s condition, especially in the elderly, to assess how sure the surgery is and how risky it is. This is because risks can be avoided by taking various measures. For example, patients with high blood pressure should have their blood pressure lowered to the normal range so that it can be controlled during anesthesia; surgical bleeding should be promptly transfused. These are all precautionary measures. If it is a surgical hazard, it is a problem. If you have preoperative atrial fibrillation or frequent ventricular tachycardia, anesthesia is dangerous, and such people may not be able to tolerate the surgery, so don’t do it.
Moderator: To sum up what you just said, not only should we judge whether to operate or not from age, physical signs and examination results. There is another hurdle, which is whether the person can tolerate the surgery or not.
Professor: So there are many items to be checked for elderly people over 70 years old, such as cardiac function, echocardiography, electrocardiogram, blood gas and so on. The high blood pressure must be controlled to a level that is too high to do at all.
”Red and hot wound, seek medical attention as soon as possible.”
Moderator: An elderly patient asked about feeling as if his surgical wound was splitting wide open. Is this normal?
Professor: It should be normal. Before the surgery, there was a lot of deformation and irregularity in the joint. We follow the routine, and after the surgery some of the bones are removed and it just doesn’t feel the same as the original. But the wound will not affect the patient too much.
Moderator: Are there any abnormal symptoms after surgery that should be seen by the doctor once they appear?
Professor: The wound is red, hot, especially swollen, there is fluid, indicating a chronic infection, we should seek medical attention as soon as possible.
”The elderly practice walking with the Xi Bu frame”
Moderator: A patient had two knee joints replaced. He felt that after the operation, the bottom was the same as no leg, and he was afraid to stand. Why?
Professor: Generally patients are reluctant to move around after surgery and are afraid. Actually, there is nothing wrong with the knee joint. Immediately after knee replacement, you can stand with weight by holding a cane.
Moderator: One of the patients asked whether to practice walking after surgery in steps, such as walking frame, single crutch, double crutch and independent walking?
Professor: No. The exercise frame has four legs, which is safer. For the elderly, it is safer and more appropriate. Young people can hold double crutches first, then single crutches, hold them for about two months, and start walking independently. This is mainly for the rehabilitation of the hip joint after surgery.
Moderator: Is there a sequence of single crutch and double crutch?
Professor: First double crutches, then single crutches, and finally throw crutches.
”The degree of extension and knee flexion can guide the rehabilitation.”
Moderator: To judge the function of the joint after surgery, is it necessary to do some assessment, such as the degree of extension and knee flexion.
Professor: How many degrees before surgery, how many degrees can be recovered now, and if you can’t straighten before surgery, and you can straighten after surgery, it means the surgery is good.
Moderator: Is this assessment a guide for future rehabilitation?
Professor: It should be.
”Walking leg is sore and swollen, consider lumbar spine problem”
Moderator: A patient asked a question about his mother’s knee flexion reaching 130 after surgery, but she cannot walk long distances or she still feels sore and a little painful. It is now 3 months after surgery, is this normal?
Professor: 3 months to review. If you are sore and swollen after walking a lot, you have to consider lumbar spine problems. It also depends on how the joints recover and whether there are any problems.