I. What conditions are suitable for knee joint replacement surgery?
(1) Various inflammatory arthritis of the knee joint, including rheumatoid arthritis, osteoarthritis, hemophilic arthritis, Charcot arthritis, etc.
(2) A few traumatic arthritis.
(3) Osteoarthritis after failed high tibial osteotomy.
(4) Patellofemoral arthritis in a few elderly people
(5) resting infectious arthritis (including tuberculosis)
(6) A few primary or secondary osteochondral necrotizing diseases. Zhu Hanxiao, Department of Orthopedics, The Second Hospital of Zhejiang University School of Medicine
What conditions contraindicate knee replacement surgery?
Total knee arthroplasty is contraindicated in the following cases.
(1) Paralysis of the muscles around the knee joint.
(2) The knee joint has been fused in a functional position for a long time without symptoms such as pain and deformity. As a rule of thumb, severe flexion contracture deformity (greater than 60 degrees), severe osteoporosis, joint instability, severe muscle weakness, fibrous or bony fusion are not absolute contraindications to surgery.
How to choose a good artificial knee joint?
When a patient decides to use artificial joint replacement as a treatment method, the question often comes up: what kind of artificial joint is the best one? It should be said that different patients should choose different artificial joints. Artificial joint prosthesis has very strict requirements for its design, surface treatment, material selection, manufacturing process and packaging; it also needs sufficient clinical practice to prove the effectiveness of a certain artificial joint. At present, the artificial knee joint has become a very mature artificial joint, both in terms of the prosthesis itself and in terms of surgical techniques. In developed countries, artificial knee joints have been widely used in clinical practice with good clinical results. Choosing an artificial knee prosthesis is very different from choosing other commodities because once the artificial knee prosthesis is placed in the body it is not easy to “replace” it at will, and even if it is “replaced” the cost is quite high and cannot be measured in money alone. Therefore, the choice of a good artificial joint should be made carefully under the guidance of an expert.
Fourth, post-operative examination
Three months after discharge from the hospital to review, take X-rays, to understand the position of the joint prosthesis and stability is good. Six months after the operation and then every six months, the X-ray should be checked. If there is discomfort, such as redness, swelling, pain or difficulty in moving the joint, or if the hip joint is injured due to an accident, go to the hospital in time for examination.
V. Duration and efficacy of the artificial knee joint
The knee joint is an important joint, it has various functions such as walking, running, jumping and squatting, and it also carries the weight of your body. Once the knee joint is diseased, the cartilage of the joint is destroyed and the surface turns from a smooth mirror-like surface to a rough or even defective surface, further deforming the femoral condyles. This results in pain, difficulty walking, limited mobility, limping, and sometimes difficulty performing even easy movements. When the above disease has progressed to a certain point and the joint has been destroyed, surgery is required. An artificial knee joint is used to replace the damaged joint (the timing of the surgery should be decided by the surgeon) to restore function such as walking. The greatest benefit of artificial joint surgery is that it eliminates post-operative joint pain, greatly improves the function of the joint, and increases the patient’s quality of life so that he or she can work and live well during their lifetime. Nowadays, more and more patients are happy to accept the suggestion of artificial joint surgery. The longevity of the artificial knee joint is determined by two main issues: the wear and tear of the joint and the loosening of the prosthesis caused by wear particles. The strength and wear resistance of the artificial knee joint material is after hundreds of wear experiments, high-quality imported artificial joints, such as the German Snake (AESCULAP) artificial joint, the United States Stryker (STRYKER) artificial joint, etc., can generally meet the patient more than 20 years. The current artificial joints used in clinical practice are much better than those used 20 years ago, and it is believed that more than 95% of the artificial joints that have been replaced for 20 years can continue to be used. A successful artificial joint replacement will allow you to live a pain-free life and meet your daily activities, and for a damaged knee, no other treatment can achieve the same results. Of course, the longevity of the 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 condition. The orthopaedic community is currently working with engineers and material scientists, among others, to improve artificial joint materials, processes and surgical techniques. The future is bright for patients who choose joint replacement to improve their quality of life and want to move around in a healthy and pain-free manner.
VI. Treatment of the artificial knee joint after loosening
Once the artificial knee becomes infected or aseptically loose, joint revision surgery is required. There are specially designed hip prostheses and surgical instruments for revision surgery. Revision surgery is more complex than the initial surgery and may involve bone grafting, changing the type of joint prosthesis or using a special prosthesis. After revision surgery, the vast majority of patients can achieve a satisfactory outcome.
VII. Protection of the artificial knee after arthroplasty
After artificial knee replacement, you need to develop good habits of life and activities to maintain the stability of the joint, and learn some simple rehabilitation knowledge to carry out joint rehabilitation exercises. It is important to pay attention to the prevention and treatment of infections such as tonsillitis, skin infections, ringworm, etc. After surgery, you can ride a bike, walk, dance, swim, etc., but running, jumping, and other strenuous exercises, as well as walking long distances and climbing mountains, are not encouraged. In addition, some hospitals provide post-operative rehabilitation manuals for patients to refer to.
VIII. Rehabilitation after knee arthroplasty
Rehabilitation exercises are essential to the success of total knee replacement surgery. Isometric contraction of the muscles of the affected limb can be performed immediately after surgery. If the joint is well positioned and fixed, rehabilitation exercises, including straight leg raising, quadriceps and walking exercises, can be started under the guidance of the physician and rehabilitation staff. Even after full rehabilitation, regular rehabilitation exercises are usually required.
IX. Advantages and disadvantages of artificial knee surgery
Artificial knee surgery began in 1960, and this procedure has been determined to be an effective surgery. However, total knee replacement has been performed in China for a relatively short period of time, and the procedure requires a very experienced surgeon to perform it. Artificial knee surgery can turn a non-mobile joint into a mobile one. However, once the surgery fails, there are few ways to make up for it.
The advantages are.
(1) The surgery can be performed on patients with worsening osteoarthritis of the knee and severe deformities.
(2) The surgical treatment period is relatively short, about one month.
(3) The joint pain can be completely removed.
The disadvantages are as follows.
(1) It has an effect on sports such as running and hiking.
(2) After surgery, the knee joint is usually bent slightly more than a right angle, about 120o.
(3) After 10-15 years after surgery, there will be loosening between the bone and the artificial joint, and the percentage of replacement needed is about 5-10%.
(4) Infection of the artificial joint is very difficult to treat; it often causes osteomyelitis of the femur and tibia. 3-5% of people have infection after surgery, which requires prolonged treatment, and treatment is very difficult, even if the artificial joint has to be removed and replaced after 1-2 years of infection control. The rate of infection in the resurfaced joints is much higher than that of the first surgery.
(5) Wear and loosening of the artificial joint is also a cause of postoperative pain and surgical failure.
(6) It is expensive and not affordable for the general public.
However, once most of the articular cartilage of the knee joint is destroyed, high tibial osteotomy cannot be performed and only artificial joint replacement or joint fixation can be performed. With the advent of aging in China, the general improvement of people’s living standard, the increase of economic income, and the implementation of social labor and medical insurance, especially the rapid spread of artificial joint technology, it is certain that the number of cases and success rate of artificial joint surgery in China will increase rapidly, and complications will become less and less.