What is the most fearful thing after knee replacement? What is the most painful thing in the world? The most painful thing for patients who have undergone artificial joint replacement surgery is that the prosthesis is broken while they are still alive, “Wait, what did you say, doctor? You said I used the best imported prosthesis, this will also be bad?” Imported prosthesis is also a prosthesis, can only say than (currently) the overall quality of domestic prosthesis is better, but does not mean that it will not break. So all of our life precautions should be around the “protection of prosthesis, when the responsibility”. If you know your enemy, you will never lose a battle. Let’s first look at what makes the replacement knee “bad”. 1. infection 2. instability of the knee joint 3. separation of the prosthesis from the bone (loosening) 4. poor range of motion of the knee joint (stiffness) 5. fracture of the knee joint (periprosthetic fracture), and some other reasons that are very low in percentage are not listed here. [1] In the case of revisions over 15 years, the main factor is the wear out of the prosthesis at the end of its useful life (end of life of the prosthesis). In response to such statistical findings, our patient friends can do the following aspects: prevention of infection, selection of hospitals, reduce wear and tear to prevent loosening, diligent exercise, fall prevention. 1, anti-infection Post-surgical infection can be divided into the infection that occurs short-term after surgery and the infection that occurs long after surgery. Many patients think that the prevention of surgical infection is a matter of doctors, in fact, we can do a lot of patients. Some patients have red, swollen and painful knee joints years or even a dozen years after surgery. This is actually a “hematogenous infection” after joint replacement. Simply put, when you have an infectious disease (bacterial infection, such as pneumonia), your blood carries a lot of bacteria, which are transported to all corners of the body by the blood circulation. Note: Bacteria also like to pinch the soft ones! What to do? The first step is of course to prevent infectious diseases such as pneumonia, urinary tract infections (cystitis, urethritis), etc. Konigsberg et al. counted 40 cases of hematogenous infections after hip and knee replacement and found that the main bacteria were streptococci (37.5%) and staphylococci (40%). Forty-five percent of these patients had definite inflammation of other sites, mainly cellulitis, urinary tract infection, post-traumatic infection, pneumonia, pharyngitis, and diabetic foot; 45% had definite fever (temperature >38.5°C) [2]. If you are unfortunate enough to have an infectious disease or a fever of 38.5°C or higher, seek immediate medical attention and do not “wait and see” as you did before surgery. In cases where the infection is not known, antibacterial drugs against staphylococci and streptococci are preferred to minimize the risk of blood borne infections as much as possible. In addition to infectious diseases, dental treatment is also very risky (e.g., tooth extraction) because it is very likely to cause bacteria to enter the bloodstream (bacteremia.) The AAOS (American Academy of Orthopaedic Surgeons) recommends that patients who have had joint replacements should be given oral antimicrobials to prevent infection prior to all operations that may cause bacteremia. Unfortunately, even with aggressive prophylaxis/treatment, hematogenous infections cannot be completely avoided, although their incidence is very, very low compared to early infections! 2, reduce wear and tear to prevent loosening First of all, different prostheses have different degrees of wear resistance (different production processes and materials of prostheses), please communicate fully with your doctor before surgery and try to choose a relatively wear-resistant knee prosthesis. Proper use of your joint after surgery is the key to reducing wear and tear and preventing loosening! You should try to avoid repeated impact on the prosthesis, such as jumping rope. “Then I should just rest except for taking care of myself!” This is not true either. You should participate in regular low-intensity exercise to maintain the mobility and muscle strength of your knee joint after replacement, just like a car breaks down faster if you leave it all the time! The best form of exercise for post-knee replacement patients is swimming because it is a total body exercise while putting almost zero load on the knee joint! In addition to changing your exercise routine, two other very popular things that are especially important are weight loss and treating osteoporosis. Obesity not only increases the risk of surgery for knee replacement, but also shortens the life of the prosthesis (just like overloading a car). (Continued attention to iron bones and tendons, to tell you the secret of weight loss) And after a certain degree of osteoporosis in old age, not only the risk of fracture increases, but also for the life of the prosthesis will have a negative impact, targeted treatment is very necessary! (Osteoporosis is also a big problem, and to be decomposed next time) 3, fall prevention Everyone should prevent falls, especially the elderly, especially the elderly after joint replacement!!! If a fall causes a fracture in the knee on the operated side, it may lead to loosening of the prosthesis and require a second surgery. And such a secondary surgery is very difficult and much more expensive than the initial surgery, and a few serious injuries may leave the surgeon feeling helpless! “Doctor, it’s just a matter of not falling, it’s easy!” “Wait a minute, it’s really not simple, it’s a technical job!” First of all, let’s look at the causes of falls: 1, their own inherent factors: advanced age, postmenopausal women (female compatriots are more likely to fall), low weight people, muscle atrophy, chronic arthritis, abnormal gait balance, previous experience of falls, malnutrition, the use of drugs (sedative, antidepressant, antihypertensive, anticonvulsant, antiarrhythmic). 2, environmental factors: nursing homes, carpet edges buckling, uneven and smooth floors, poor lighting, ropes (wires) on the floor, stools without handrails, and improper shoes. Some of these factors cannot be changed, and by improving some others, we can reduce the risk of falls for seniors by about 70%! Please note that it is easier to know than to do! Implementing the methods into your life is what counts! Exercise the body. The main exercises are strength, balance, endurance, and flexibility. Exercise should be done with high frequency (exercise regularly) and low intensity (don’t get tired), while group exercise is better than individual exercise! Adjust the medication structure. If you need to take many different medications at the same time, these medications may have a superimposed effect on the risk of falls, ask your doctor to adjust the structure of your medication to minimize the risk of falls from medication. Choose the right shoes. A good pair of shoes can reduce the risk of falls. Wear shoes with better slip resistance when you go out, and anticipate road conditions. At home, please try to reduce the wearing of slippers, which can increase the risk of falls for the elderly. Change the “harmful” environment in the home. In the environmental factors, the home can be improved in many places, such as do not make the carpet edge, do not pull in the ground rope, wire, maintain good lighting, in the bathroom, steps, stairs and other places to install handrails, kitchen, bathroom attention to non-slip and so on. Avoid “golden chicken independence”. Some elderly people still like to stand like when they were young to put on and take off pants, but I do not know that the elderly standing position to put on and take off pants is very unsafe! Especially just after bathing, it is easy to appear weak, and even dizzy phenomenon, must be avoided! Actively use a cane. When you get older and your legs are not good, finding a helper is the easiest way! Please be brave and pick up a cane! (A small cane can do a lot) There are many fall prevention considerations listed above, please note: falls are often the result of many factors working together, so we should take comprehensive measures and not lose sight of one! Among the main causes of secondary surgery, “poor knee range of motion” is mainly a consequence of poor post-operative exercise, and functional exercise is very important to restore the function of the knee replacement (exercise regularly). The main cause of “instability” is the surgical procedure itself, so please go to a hospital with a large surgical volume for surgical treatment (choose a hospital). In addition to your own awareness and protection, don’t forget to see your surgeon once a year to assess the status of the prosthesis and the function of your joint. You can also ask your doctor to give you a heads up through the follow-up! Although we are functioning well now, we have a “baby” in our body that needs more care.