The most typical manifestation of osteoarthritis of the knee is swelling and pain in the knee joint, especially in the morning, when walking up and down stairs, and when bearing weight. If the pain is still unbearable after trying medications, arthroscopy, etc., or if severe O-legging occurs, making it difficult to walk and seriously affecting daily life, patients may choose to have knee replacement surgery at this “last minute”. However, these older people often have many concerns about this surgery and are unable to make the “hard decision” to have the surgery. Concerns 1: There is no need to spend money when you are old and have bad legs and feet. Many older people think that knee pain is not a disease and that there is no need to spend money on surgery. In the days when technology was not developed and medicine was not developed, there was some truth to this statement, or so it seemed. But today, with the advent of medicine, the elderly are not only seeking to live longer, but also to live a quality life. When we get old and lose our teeth, we get dentures to eat better; similarly, when our joints are bad, we can get a “prosthetic” joint. In addition to pain, osteoarthritis of the knee in the elderly often brings other problems. For example, some patients have trouble getting up when they squat in the toilet. This inconvenience in life often leads to falls and even head trauma, bleeding, fractures, etc. In addition, the severe pain and deformation of the knee joints lead to mobility problems, which may lead to uncontrolled or further aggravation of medical diseases that previously required exercise regulation, such as diabetes and coronary heart disease. Therefore, although all knee joints will hurt as we age, we should go to a regular medical institution and let the doctor determine how bad the joint has become, and if joint replacement surgery is really necessary to improve the disease and quality of life. Then, we can choose to replace the artificial joint just like we choose to replace our dentures. Concern 2: The artificial joint is a prosthetic leg after all, not as good as your own leg Nowadays, knee replacement technology is very mature, and patients can resume normal activities after surgery, such as daily walking and cycling, common household chores, sexual needs, and many can even return to some low-intensity physical exercise. The reason for this concern is that many patients think that knee replacement surgery means replacing the entire joint with a prosthetic one. In fact, the full name of a knee replacement is called a total knee surface replacement. Like a nail palm, the surgeon simply removes the worn cartilage and some of the subchondral bone from the surface of the joint, puts a metal “face” on it, and then puts a polyethylene plastic spacer in the middle. The joint is still your joint, not damaging your own nerves or affecting your sensation, but the friction surface is replaced with metal and plastic. With today’s medical care, patients are generally able to get off the floor and live basically on their own 2-3 days after knee replacement. within 4-6 weeks they are walking with a walker. Often, when walking to the outpatient clinic for a review at 2-3 months, it is not obvious that the person has had surgery. So after the artificial knee replacement, your leg will still be your leg, but it will be a “painless, freely moving” leg. Concern 3: People who have had the surgery say that it is particularly painful because the bones have to be sawed. There is a concept of “pain-free wards” in knee replacement surgery, just like “pain-free childbirth,” which is designed to prevent excessive pain and unpleasant experiences before, during and after the surgery. The aim is to avoid excessive pain and unpleasant experiences before and after the procedure. Thanks to improvements in pain medication and anesthesia, current artificial knee replacements are completely painless to the patient during surgery. The knee gradually regains local sensation after surgery, but the patient does not feel excessive pain due to PCA analgesia (a pain pump controlled by the patient), nerve block anesthesia (which simply makes the operated leg painless without interfering with its movement), and the use of various pain medications. It is true that there is a certain amount of pain after joint replacement surgery, and this pain occurs mainly during the functional rehabilitation after the surgery. This pain is acceptable to the patient and is necessary for recovery. However, the joint surgery ward nowadays is far from the imaginary scene that patients have to endure like Guan Gong scraping the bones. Under the guidance of the “pain-free ward”, “multi-modal analgesia” and more advanced rehabilitation concepts, patients can get through the surgery and post-operative training with ease. As the rehabilitation process progresses, patients will eventually achieve a completely pain-free, freely moving knee. Concern #4: I am too old and have too many medical problems, so the risk of surgery is too high. Doctors who perform joint replacements often joke that they are half geriatricians, because most joint replacements are performed on older people, and most have a variety of medical conditions combined. Joint replacement is generally not a high-risk procedure, and experienced surgeons often end the battle within an hour, so it is not too disruptive to the patient. Older adults with medical conditions can bring their various test results and labs to the clinic and consult with the surgeon if the risk of surgery is assessed to be acceptable. If the risk of surgery is assessed to be too high, then other treatment options with lower risk can be chosen, or they can wait for further control of the medical disease before undergoing surgery under the treatment of an internal medicine doctor. Concern 5: You can’t do MRI after replacing the artificial joint, you can’t fly, and the artificial joint will wear out in a few years. The mainstream artificial knee joint is mainly made of metal surface made of cobalt-chromium-molybdenum alloy and spacer made of polymer polyethylene. Although it is also metal, it is a non-magnetic metal. In other words, if you have an artificial joint, you can go to the MRI and fly on a plane without worrying, and it will not alarm you when you go through security. With regard to the service life of artificial joints, most scholars believe that they can last at least 20 years with proper surgical technique and normal patient use. However, no one can tell you exactly how many years it will last because it depends on many factors. However, there is absolutely no evidence to support the idea that “sparing” the use of an artificial joint after it has been done will extend the life of the joint. Concern #6: Artificial joints have a life span and the later you have them, the better. It is important to understand that due to advances in prosthesis design and material science, most modern artificial knees have a life span that can meet the needs of older adults (>60 years). So while the artificial joint has a certain lifespan, the later the procedure is done, the better. First of all, osteoarthritis of the knee is a continuous progression, and the pursuit of “late” surgery may lead to further aggravation of the osteoarthritis of the knee, more bone fragments, more severe deformities, and more severe soft tissue contractures. This makes surgery more difficult, and post-operative rehabilitation takes longer and is more difficult. There are even times when osteoarthritis is so severe that there is loss of ligament function or large bone defects, and the surgeon must use very expensive artificial joints to perform the surgery, and at this time both the surgical results and the patient’s self-satisfaction are not as good as when the disease is not so severe, and the surgery time, risk, and cost are also much higher than conventional surgery. Secondly, as the elderly age, their body functions and tolerance to surgery are getting worse. Therefore, if you pursue surgery “late”, you may miss the best time for surgery. Therefore, it is possible to miss the best time for surgery, or to let a surgery that is not very risky become more risky due to some geriatric complications caused by prolonged delay. Therefore, the timing of surgery should be determined by the extent of the patient’s disease and physical condition, not just the later the better. The price of knee replacement depends mainly on the number of replacement sites and the material of the replacement prosthesis. Total knee replacement is relatively expensive; if you choose a domestic prosthesis, the cost is about $10,000 and the full cost of the surgery is about $13,000 to $14,000; an imported prosthesis costs $30,000. The main difference between the two is the degree of wear resistance of the plastic pad in the middle of the prosthesis, the imported prosthesis uses polymer materials, good wear resistance, the current domestic prosthesis is also improving, in general, the domestic prosthesis can also be used for more than 20 years.
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