The German Gluck invented the artificial hip in 1891, first replacing the hip with a femoral head made of ivory, and Smith Peterson began using metal (cobalt alloy) for single cup hip replacements in the 1940s. The real modern use of artificial joints began in the 1970s with the work of John Charnley, who established principles that are still used today, and it was his first satisfactory results in the hip that encouraged research into prosthetic replacements for other joints.
The development of artificial joint replacement technology has given hope to some patients with rheumatoid arthritis who have advanced severe joint destruction, and some patients who have been bedridden for a long time have been able to regain standing and walking function and partially or completely regain their ability to care for themselves through surgery. It is now widely used at home and abroad as a mature treatment method.
Hip joint replacement is very effective, and the long-term efficacy of hip joint replacement for patients with rheumatoid arthritis seems to be similar to that of osteoarthritis, with a general 10-year excellent rate of about 90%. The main problems currently exist are.
① severe osteoporosis and acetabular endoconvexity affecting the fixation of the prosthesis, especially the fixation of the acetabular prosthesis.
(ii) the method of repairing bone defects in revision surgery.
③How to improve the surgical outcome of patients with juvenile rheumatoid arthritis and ankylosing spondylitis, etc.
The results of knee replacement are similar to those of hip replacement, and the main issues are.
(i) fixation of the platform prosthesis.
(ii) problems of infection and revision surgery.
③ alignment and alignment of patellofemoral and tibiofemoral joints, etc.
Although patients are generally satisfied with the pain relief and functional improvement after surgery, this procedure should be applied with caution.
Metacarpophalangeal and metatarsophalangeal joint replacements are still more commonly performed with silicone prostheses and have more definite results, but complications (e.g., prosthesis loosening, fracture, deformity recurrence, etc.) are still common. In recent years, the results of surface-type prostheses are not very optimistic, mainly because of the lack of strong soft tissue around these small joints to maintain joint stability.
The elbow, wrist, and shoulder joints are non-weight-bearing joints, and arthroplasty is not always necessary for most patients through synovectomy or other orthopedic surgery, as well as motion compensation between all other joints. In recent years, with the advent of joint surface replacement and new prostheses, the number of elbow joint replacement surgeries and postoperative outcomes have improved significantly.
The artificial joint is, of course, a “prosthetic joint” and has long-term complications such as loosening of the prosthesis and infection, which can be remedied by revision surgery, but revision surgery is much more complex than the initial surgery and the results are not ideal. Based on these circumstances, surgeons are naturally faced with the practical question of whether it is appropriate to perform arthroplasty on younger patients, especially those with juvenile rheumatoid arthritis, because they will face greater functional needs after surgery and will be subject to various postoperative complications for a longer period of time. Due to the late start of rheumatoid arthritis surgery in China, there are still a significant number of younger patients who have not received reasonable treatment. Many of these patients have severe joint deformities and dysfunctions, the severity of which is hardly seen in developed countries. For such patients, if they continue to wait, it will seriously delay the patients’ major life issues such as study, employment and marriage. Many patients, due to the lack of timely treatment, develop light-hearted or even suicidal thoughts to relieve pain and disappointment in life. The authors believe that artificial joint replacement should be performed on these patients as soon as possible.
In the authors’ clinical practice, one of the most frequently asked questions from patients is “How long will the artificial joint last?” When they hear that the artificial joint may have complications of one kind or another and that it will most likely need to be reoperated in the future, some patients, and even some physicians, advise the patient to abandon the surgery on the grounds that it will cost them money, they will suffer, and they will not be able to get it done once and for all. The authors believe that this view is wrong, because there is a quality of life issue here. We have this example: a patient with rheumatoid arthritis who has been completely bedridden for 8 years, 35 years old at the time of admission, with all joints of the body involved, especially both hips, both knees and both feet are severely damaged. For such a patient, it was not only a burden for the family and society, but also the long-term psychological pressure and pain had made him lose his courage to live. The patient’s osteoporosis was very serious and his general condition was not ideal, but the author still performed an artificial joint replacement for the patient. After the surgery, the patient was able to stand and walk again, and was able to perform basic activities of daily living and partially resume his previous work.
It is fair to say that in a patient of this severity we already knew before surgery that the long-term outcome would not be good and that complications such as loosening of the prosthesis would occur sooner or later, but the authors also believe that it makes sense to create a near-normal life for such a patient for several years. A person’s life is not just about survival per se, but the quality of life is more important, and it is totally worth the risk of surgery and the pain it causes to improve the quality of life. Imagine a patient who is completely bedridden and has lost his confidence in life, what is the value of his life if he continues conservative treatment, even if he lives to the age of 100? If the patient is allowed to continue to lie down until the age of 60 before surgery in order to reduce the number of operations, how much more meaningful is the surgery? This is actually the issue of cost to benefit ratio that the authors have emphasized in the previous article. In the future, 10 to 20 years from now, even if there is a problem with the artificial joint, it can be repaired. Furthermore, with social development and technological progress, there is every reason to believe that artificial joint technology will be even better by that time.
The question of whether to perform artificial joint replacement in young patients with arthritis is a special issue before orthopaedic surgeons worldwide. The authors strongly agree with Scott’s view that it is better to wait until the epiphysis is closed and the bones are thicker and the patient is better able to cooperate with postoperative rehabilitation in young patients with rheumatoid arthritis, if the epiphysis is immature. If soft tissue release, osteotomy and synovectomy can solve the problem, artificial joint replacement should be avoided as much as possible. The authors also believe that the benefits of prosthetic arthroplasty for young patients with arthritis will far outweigh the potential complications if the patient has access to a custom-made prosthesis. In addition to improving function and correcting deformities, the greatest benefit is that it allows these patients to attend school, work, and marry at the peak of their lives, as well as their peers, improving quality of life and making life more rewarding.
I. What conditions are suitable for knee 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.
Second, the duration of use and efficacy of artificial knee joint
The knee joint is an important joint that 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, which further deforms 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 doctor should decide when to operate) 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 artificial joints currently used in clinical practice have improved a lot compared to 20 years ago, and it is believed that more than 95% of the artificial joints placed now can continue to be used after 20 years. A successful artificial joint replacement will allow you to live pain-free and meet your daily activities, and no other treatment can achieve the same results for a knee that has been damaged. Of course, the longevity of the artificial joint is also dependent on many factors, such as the patient’s exercise level, 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.
Cost: The cost of total knee replacement is generally $8500, or RMB 50,000 to 60,000, which is good ~ expensive, imported hundreds of thousands, but there is no need to use ~
IV. Advantages and disadvantages of artificial knee surgery
Artificial knee surgery began in 1960, and this surgical method 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. 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) The degree of knee flexion after surgery is usually slightly greater than a right angle, about 120o.
(3) After 10-15 years after the surgery, the bone and the artificial joint may loosen and need to be replaced by about 5-10%.
(4) The treatment of artificial joint infection is very difficult; 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 then the joint is replaced after 1-2 years of infection control. The infection rate of the re-surfaced joint is much higher than that of the first operation.
(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 popularization 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 the complications will be less and less.