What is the purpose of artificial total knee joint replacement?
It is a treatment to replace the damaged joint with an artificial joint component to correct the force line of the limb, eliminate knee pain, maintain joint stability, and restore knee function.
What kind of people are suitable for artificial knee replacement?
For patients with severe osteoarthritis, ankylosing spondylitis, rheumatoid arthritis and other diseases that cause knee joint destruction, knee inversion or flexion contracture deformity, and other knee joint pain, instability, deformity, and severe limitation of daily life and activities, and for whom conservative treatment is ineffective or ineffective. Patients with active infection of the knee joint, tuberculosis, and severe muscle and nerve dysfunction are not suitable for knee replacement.
At what age is an artificial knee joint replacement suitable?
In the past, the optimal age for artificial knee replacement was 55-75 years, but with the continuous development of artificial joint technology and improved surgical techniques, as well as an increase in the average life expectancy, the age range for artificial knee replacement has tended to expand. Age is not the primary consideration, but rather the decision is based on the patient’s health and symptoms and the degree of knee pathology.
How long will the artificial joint material last?
This question is always a major concern for patients, and experts point out that the 20-year prosthesis survival rate is over 90%.
Of course, the service life of the artificial joint is also related to many factors, such as the patient’s primary disease, the quality of the local bone and soft tissue, the surgeon’s surgical technique, the design and material of the prosthesis, and the patient’s use of the “new joint”.
How to choose an artificial joint?
Different types of prostheses are available depending on the patient’s age, expectations of the surgery, financial situation, exercise level, etc., as well as the experience and recommendations of the joint surgeon.
What are the complications and risks associated with artificial knee replacement?
Complications can occur with any surgery, and it is important to assess the risks and complication rates of the surgery and manage and prevent them accordingly for your condition. Knee replacement is a level 4 orthopedic procedure and there are a variety of complications that can occur including
1. Infection: This includes skin infection and deep wound infection. Prevention methods are preoperative, intraoperative and postoperative application of antimicrobial agents and aseptic operation.
2, thrombosis: lower limb thrombosis is more common, and most of them can be cured. Prevention methods are application of anticoagulant, application of intravenous pump, muscle contraction exercises, etc. Lower limb elevation on a soft cushion to reduce pain and help lower limb blood return, 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?
Intraspinal anesthesia and general anesthesia can be used. Patients with lumbar anesthesia belong to the awake state and recover quickly, but they are slightly tired with the same posture during surgery; elderly patients, patients with difficulty in lumbar anesthesia for lumbar spine hyperplasia and those who request it themselves
Patients can choose general anesthesia, sleep during the operation and wake up after sleep. According to the patient’s request whether to choose pain pump.
Is the pain after artificial knee replacement serious?
Many hospitals are now offering pain-free wards. With the current analgesic model, patients generally experience less pain and have a higher level of early joint recovery and patient satisfaction.
How long is the hospital stay for knee replacement?
After 1-3 days of necessary preoperative examination and laboratory tests, if there are no contraindications to surgery, the patient can be operated and discharged one week after surgery.
Can patients with high blood pressure, heart disease and diabetes have knee replacements?
Patients with hypertension can have a knee replacement if they can control their blood pressure with medication and have no other complications caused by hypertension. Joint replacement is also possible if the patient has heart disease but is in good heart function, without serious arrhythmias or angina pectoris. Diabetic patients with normal blood glucose control and no serious complications due to diabetes are eligible for knee replacement surgery. 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, depending on the patient’s age and physical condition. 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 rebuilt after it has worn out or loosened?
Yes. If the artificial knee becomes infected or loosens, a “revision surgery” will be required. Special knee prostheses and surgical instruments are 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 prevent fall trauma?
1.Falls can cause torso injuries, which can even be life-threatening in serious cases
2.When the patient is agitated, unconscious or unable to take care of himself
3.When changing position, you should follow the “trilogy”: get up from bed for at least 30 seconds, stand for at least 30 seconds, then walk, avoid sudden changes in position, especially at night.
4.When walking out of bed, someone should support you and wear non-slip shoes
5. When urinating and defecating, it is recommended to do so by the bedside, not in the bathroom, to avoid slipping and falling.
6.The first time to get out of bed after surgery should be agreed by the doctor in charge and guided by professional staff
7.You need to use auxiliary equipment and have someone accompany you when you get out of bed after surgery
8.If you experience dizziness, black eyes, weakness of lower limbs, unstable gait and other abnormalities when standing or walking, please immediately squat in place or lean against the wall and call others for help.
9.Please do not walk on slippery or uneven ground
10.Please press the call bell when you need help, the medical staff will give help in time.
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 the operation; practice bed urination and defecation to prevent unaccustomed to bed after the operation; keep the body clean and treat the infection foci such as cold and pneumonia; treat the combined hypertension, heart disease, diabetes and other diseases; preoperative instruction: first of all, strengthen the static contraction exercises of the quadriceps muscle of the affected limb and the active movement of the ankle joint. 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 during surgery”, and eating more fish can increase protein very well.
The role of postoperative cold therapy
1, small blood vessel contraction exudation is reduced, which is conducive to tissue repair
2.Sensory nerve fiber conduction speed slowed down, there is a more obvious analgesic effect
3.Reducing muscle excitability, with a better antispasmodic effect
4.Local tissue metabolism is reduced, which is conducive to the treatment of early inflammation and soft tissue
5.Reduces the excitability of sensory nerves, relaxes muscles and has an analgesic effect
6.Eliminate the fatigue after exercise
Purpose of rehabilitation after total knee arthroplasty
Strengthen the muscle strength of the flexors and extensors around the knee through muscle strength training, and promote the recovery of the whole body strength and condition. Through walking or other coordination training, improve the muscle strength around the knee joint and its soft tissue balance and coordination to ensure joint stability Through joint mobility training, make the knee joint activities can meet the needs of daily activities and some social activities Prevent post-operative joint adhesions, improve local or whole lower limb blood circulation, and avoid some post-operative complications Improve patients’ mental and psychological outlook and stimulate enthusiasm for life.
Rehabilitation plan
1. On the day of surgery: exercise of pulmonary function, such as deep breathing and coughing, to prevent pneumonia. After anesthesia disappears, dorsiflexion and plantar flexion of ankle joint, toe movement
2.Day 1 after surgery: sitting position is advisable to facilitate coughing and prevent pneumonia; exercise of upper limbs to facilitate future walking exercises; isometric contraction of quadriceps
3.Day 2 after surgery: remove the drainage tube and use CPM (lower limb mobility device) for functional exercise after taking pictures to determine the proper position of the prosthesis. Starting at 30o, passive flexion of the knee joint was performed. At this point, you can stand down, walk with your leg elevated, and actively and passively flex or straighten the knee joint. Within 1 week, try to flex the knee joint to 90 or more. practice straight leg raising, use the healthy foot under the affected limb to help raise the affected limb. Do static contraction of the quadriceps muscle on the affected limb, hold for 10 seconds each time, every 10 times for 1 group, 10 groups per day; the patient sits on the bed and the affected limb does straight leg raising exercise, not requiring lifting height, but about 10 seconds of lag time.
4, 3-7 days after surgery: walking 50-100 meters; passive activity of knee flexion 100-110o, active activity of flexion 80-90o; muscle strength at straight leg raising is grade III (demonstrated by the ability to actively lift the leg)
5, 8-14 days after surgery: 120o passive knee flexion, more than 90o active knee flexion, 0o knee extension; muscle strengthening exercise, 15-20 minutes on a stationary bicycle, able to go up and down stairs
How to practice leg lifts
From the first day after surgery, we should practice leg lifting. Specific practice foot: first force the back of the foot upward hook, then force the leg straight, then the whole leg will be raised to half height, maintain at this height for 10 seconds and then put the leg down, and completely relax, the above is an exercise. Exercises should be performed in groups, each group 5 to 10 times, 3 to 5 groups per day. The specific amount of exercise depends on the physical condition. If the exercise volume is too large at the beginning, there will be pain in the back of the leg.
How to practice leg bending
In the beginning, practice bending can be done on the side of the bed. The leg can reach 90 degrees by virtue of gravity hanging under the bed. Then you can increase the bending angle by putting the healthy limb in front of the calf of the affected leg and helping to press it backwards. The amount of force used should be tolerable, and it is better if the force can be maintained for a few minutes.
How to do leg press exercises
Put your leg straight out on the bed and put your hands above the knee and gently press down to straighten the leg as much as possible, maintaining it for about 5 minutes each time, which is the best way to exercise leg straightening.
How to master the amount of exercise
The amount of training should be small to large and progressive, so as not to cause significant pain and swelling discomfort in the affected knee.
It is not the quantity, but the quality of the daily flexion and extension activities. Try to straighten the joints and flex the joints to a certain degree so that there is progress every day. If this happens, the number of flexion and extension activities must be reduced. Usually, joint swelling occurs when there is too much activity within 3 months after surgery.
How can I continue my rehabilitation after discharge from the hospital?
After discharge, 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 generally walk independently after 2-3 months.
Daily precautions after knee arthroplasty?
1. Proper rest and exercise Continue to perform straight leg raising, walking, knee extension and flexion exercises, active ankle dorsiflexion and plantarflexion activities, and gradual up and down stairs as tolerated. Pay attention to gradually increase your activity, avoid too much strain, and have a moderate amount of rest after exercise, so that the joints can relax as much as possible in a normal posture.
2. Continue to take oral Bactrim anticoagulation for 10 days.
3. Pay attention to safety during activities and prevent trauma.
4. Maintain ideal body weight to reduce the burden on the knee joint.
5, Daily activities should avoid excessive burden on the knee joint to reduce the chance of joint wear and tear. For example, use a cart to carry heavy things instead of carrying them, and use handrails to go up and down stairs.
6.After knee surgery, please avoid the following movements: squatting, climbing, running, lifting heavy objects, and walking long distances.
7. Observe the activity restrictions given by your physician until your next follow-up appointment.
8.Six months after surgery, you can swim, ride a bicycle and return to normal life.
9.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.
10. It is normal to take pictures every 1-2 years after surgery to keep information and review for comparison use.
The “normal phenomenon” after knee arthroplasty
1. Why is there a “numbness” or an “electrical” pain around the wound?
This is due to regeneration of the neurocutaneous branches that innervate the skin on the outside of the incision and does not affect daily activities or rehabilitation.
2.Why do the joints feel swollen and warm, and how long does it take to recover?
Within 3 months after surgery, the knee joint of the affected limb often has a low degree of fever, and the floating patella sign is weakly positive. This is either a response to the replacement prosthesis or due to stimulation of the knee joint during functional training. This inflammation is not caused by bacterial infection, but there are symptoms such as redness, swelling, heat and pain; the swelling is caused by joint effusion, a small amount of which can play a lubricating role and facilitate joint movement, while a large amount of joint effusion can be extracted by arthrocentesis. The above symptoms can gradually disappear within six months after surgery.
3.Why does the affected limb have pain or soreness at night and stiffness in the morning before getting up?
During the post-operative rehabilitation process, with the increase of training intensity and frequency, some patients may experience soreness of the joint at night and stiffness of the joint when waking up in the morning, especially during the day when they are more active. The intensity of the pain is related to the patient’s preoperative knee function status. The lower the knee function score, the more pronounced the training-induced pain may be.
4. Why do I always feel tightness around the knee joint?
This is mainly due to the scar formation after surgery, which can be gradually pulled apart through exercise, and the feeling will disappear.
5. Why do I feel stiff or unnatural when walking?
After arthroplasty, as long as the patient can take care of daily activities without joint pain and the joint flexion and extension reach the expected level, the expected result can be considered. Early post-operative stiffness is normal and is usually relieved to varying degrees in 6-8 weeks, and knee mobility is basically restored within 3 months after surgery.
6. What is the “coughing sound” in the knee joint during the activity of some patients?
This sound is generally due to the soft tissues around the prosthesis being loose at the time of installation, muscle weakness and lack of sufficient strength to maintain balance. The sound is caused by the collision between the prosthesis and the femoral condyles when the prosthesis is moved, especially the hip bone. This sound rarely has clinical symptoms, but can cause psychological tension in the patient. Over time, this sound will disappear as the soft tissues repair their own balance. However, when the symptoms are obvious, a medical professional should be consulted to rule out the possibility of hip slippage.
In conclusion, the above phenomenon is a normal reaction in the rehabilitation and functional training after artificial total knee arthroplasty, and patients do not need to worry about it so much that they lose their courage and confidence in further rehabilitation treatment, which will affect the recovery of postoperative joint function. In addition to taking advantage of the outpatient review opportunity to receive professional advice on the recovery of the prosthesis and the function of the affected knee, patients should consult with a physician to identify any other problems that may arise during the late rehabilitation process.
When should I go to the hospital immediately?
Late post-operative infection is the most serious complication after prosthetic joint replacement, and in severe cases, the prosthesis may even have to be removed, thus leading to complete failure of the artificial joint. Symptoms of infection are usually marked localized warmth, redness or a large amount of fluid in the affected knee. When a patient has a cold or other acute infection, antimicrobial agents should be given to prevent late infections; if you find local redness, swelling or a “red bag” protruding from the affected knee, antimicrobial agents should be administered and the patient should be seen immediately at a hospital, not at a local non-specialized clinic, to avoid delays or incorrect treatment.