A. You don’t have to suffer from joint pain
The joints are involved in almost every activity you do. Simple activities such as walking, bending, and turning involve the hip and knee joints, and normally all parts of these joints work together and move freely without pain.
This brochure will tell you if you need to have artificial joint replacement surgery (Figure 1 – 2) (Figure 1 – 2)
It will help you understand the causes and treatment of joint pain, and more importantly, it will give you hope and confidence that you can do more than what you are experiencing without having to endure joint pain.
After reading this booklet you can ask your doctor all the questions you need to ask to gain as much knowledge as possible to help you choose the best treatment options to reduce your joint pain, get back to your normal lifestyle, and enjoy your life better.
Understanding the causes of joint pain
1. What are joints?
A joint is made up of a bundle of tissue called a ligament that connects two or more bone ends together, such as the knee joint, which is made up of the proximal end of the lower leg bone called the tibia and the distal end of the thigh bone called the femur (Figure 3); the hip joint is a ball¾socket joint, made up of the femoral head¾ball at the upper end of the thigh bone and the acetabulum¾round cup in the pelvis (Figure 4).
The surface of the endosteum of the joint is covered with a layer of smooth, clear cartilage, and normal articular cartilage moves with almost zero friction. The other surfaces of the joint are covered by a thin layer of smooth lining tissue called the synovial membrane, which produces synovial fluid as a lubricant to reduce joint friction and wear (Figures 5-6).
2. Common causes of joint pain
Arthritis is one of the most common causes of joint pain, and the common types of arthritis are.
? Osteoarthritis (OA) ¾ it is caused by the collapse and wear of joint cartilage, sometimes called degenerative arthritis, commonly known as osteophytes, long bone spurs in the joints, age-related arthritis, joint aging (Figure 7-10), cartilage wear and tear of the exposed bone corresponding to cause joint pain, osteoarthritis usually occurs in people over 50 years of age, people with a family history of osteoarthritis are more likely to develop.
? Rheumatoid arthritis (RA) ¾ synovial lesions cause thickening and inflammation, in turn synovial fluid damages cartilage (Figure 11-12), eventually causing loss of joint cartilage and joint pain, rheumatoid arthritis develops in a male to female ratio of 1:3 or higher, and can involve other organs of the body.
What are the causes of rheumatoid arthritis? Traumatic arthritis (PTA) ¾ occurs after joint injury, where the bone and cartilage fail to heal well, and the joint surface is no longer smooth and flat, causing increased wear on the cartilage surfaces of the joint (Figure 13).
? Ischemic necrosis (AN)¾ occurs when the normal blood supply to the bone is disrupted. Ischemic necrosis of the bone is not able to obtain nutrients from the blood, making the bone structure weak causing collapse and destruction of the articular cartilage surfaces, which can also occur after long-term hormone use and fracture (Figure 14-15).
Joint deformity and direct damage can also cause joint pain, sometimes due to reluctance to use an already painful joint, and muscle atrophy eventually makes joint movement more difficult.
III. Obtaining an accurate diagnosis
Community physicians, internists, rheumatologists, and Chinese orthopedic surgeons may use conservative treatments to manage arthritis and joint degeneration. However, when conservative treatments are not effective or are ineffective, a joint surgery specialist should be consulted to see if surgical treatment is needed, and sometimes the joint surgery specialist is the first physician to give the patient a diagnosis of arthritis.
Arthrosurgical evaluation.
Although each joint surgical evaluation may be different, the joint surgery specialist will consider many of the most commonly used tests to assess the patient’s condition.
A typical joint surgery evaluation will include.
? A detailed medical history
? Physical examination
? Radiographic examination
? Other tests if needed
A medical history helps the joint surgeon assess your general health and possible causes of joint pain/stiffness, and it also helps the doctor determine the extent of joint pain that is affecting your current mobility.
The physical examination includes standing, gait, sitting, lying down, and a detailed physical examination to help determine or rule out a possible diagnosis. The physical examination also allows the joint surgeon to evaluate other important aspects of the hip, knee, and lower extremity, including.
? Size and length
? Muscle strength
muscle strength Range of Motion
? Swelling
? Reflexes
? Skin conditions
If you have hip pain, the low back should be examined, as hip pain may be caused by lower back pain.
After completing the physical examination, radiographic evaluation is usually the next step in making a definitive diagnosis. Radiographs help to show the extent of joint destruction and deformity, and abnormal radiographs may show (Figures 16-19).
? Narrowing of the joint space.
? cystic cavity-like changes in the bone.
? marginal bone spur formation.
? areas of sclerotic bone thickening.
? deformities and abnormal lines of force.
Occasionally, other tests may be needed to clarify the diagnosis. Blood, urine, and synovial fluid tests may be helpful in identifying specific types of arthritis and ruling out other conditions, lumbar x-rays may help clarify that hip pain/stiffness is not caused by low back problems, and MRI and bone scans may be needed to determine the bone and soft tissue status of the affected joint.
To help your joint surgeon reach a diagnosis, it may be helpful to write down the answers to the questions listed below when you visit your doctor.
? Where and when the pain/stiffness is present.
? How long the pain has been present.
? Whether there is pressure and swelling around the joint.
? What household tasks are now difficult to complete.
? whether the joint has been injured or overused.
? Is there anyone else in the family with a similar condition.
IV. Treatment options ① Lifestyle improvement ——-®② Non-surgical conservative treatment ——-®③ Surgical treatment
After completing the joint surgery evaluation, the joint surgery specialist will review and discuss the results with you. Depending on the doctor’s diagnosis, treatment options include.
? Taking medications
? Physical therapy
? Injections of joint lubricants
? Artificial joint replacement surgery
1.Take medication
There are many types of medications available to treat joint pain. One of the most commonly used medications is non-steroidal anti-inflammatory drugs (NSAIDs), which can be taken long-term to reduce the pain and swelling caused by arthritis.
Cox-2 inhibitors are a relatively new drug that has shown significant benefits in the treatment of osteoarthritis, resulting in reduced inflammation within the joints.
It should be noted that both non-steroidal anti-inflammatory drugs (NSAIDs) and Cox-2 inhibitors have side effects that can cause stomach pain, and many people have serious stomach problems such as indigestion, heartburn and ulcer formation, and in a few cases bleeding without warning, and NSAIDs and Cox-2 inhibitors should not be taken by patients who are allergic to aspirin.
Hormones can reduce severe joint pain and swelling. Intra-articular injection of hormones can provide rapid and effective relief of joint pain, but hormones can only be used 3-4 times a year. Hormones can damage bone and joint cartilage, and hormones can cause other potentially serious side effects, and they must be used under medical supervision.
2.Physical therapy
Physiotherapy may be beneficial for both osteoarthritis and rheumatoid arthritis, for example
? Isometric exercises help to increase muscle strength without excessive wear and tear on inflamed joints
? Isotonic exercises help to further strengthen the muscles and protect their function
? Walking with a cane or other aids if necessary
3.Injection of joint lubricant
For patients who cannot improve their knee pain with medication and physical therapy, joint lubricant injections may provide temporary relief, but the degree and duration of joint pain relief varies greatly from patient to patient. replacement surgery.
4. Artificial Joint Replacement Surgery
Artificial joint replacement surgery is often used to treat patients with severe arthritis. Most patients (over 98%) who have an artificial joint replacement are older than 45 years old, but due to recent advances in artificial joint replacement surgery, patients should be considered for artificial joint replacement surgery if they have the following conditions
? have functional limitations not only for work and play, but also for normal activities of daily living.
? have joint pain that is not effectively relieved by conservative treatment with a cane, restriction of activities and all of the above.
? Significant stiffness of the joint.
? X-rays showing progressive arthritis and other problems.
V. What is Artificial Joint Replacement Surgery
Artificial joint replacement surgery is a surgical procedure in which the surgeon replaces parts of the hip or knee joint that have been removed due to arthritis or injury with plastic and metal parts called prostheses that are designed to move as freely as a normal, healthy joint.
The artificial ball head with its stem is made of super alloy, and the artificial socket cup is made of polyethylene (plastic). In a total artificial knee replacement, the metal and polyethylene artificial joint replaces the diseased knee surface, and the bone is fixed in place with bone cement or by making special holes in the surface of the metal prosthesis to allow the bone to grow in. The artificial joint prosthesis is fixed with bone cement or a special micro-hole in the surface of the metal prosthesis to allow the bone to grow in.
Modern total hip replacement surgery (Figures 20-23) and total knee replacement surgery (Figures 24-27) were first performed in the 1960s, and today it has been found that joint function is significantly restored and joint pain is significantly reduced or even eliminated in more than 95 percent of patients.
VI. Recent Advances in Artificial Joint Replacement Surgery
In 2003, a total of 1.6 million artificial joint replacement surgeries were performed worldwide. The United States, with a population of less than 300 million, performed about 625,000 total hip replacement surgeries and total knee replacement surgeries using metal/plastic prostheses; Taiwan, with a population of only 23 million, performed 50,000 artificial joint replacement surgeries; and China, with a population of 1.3 billion, performed about 60,000 artificial joint replacement surgeries in 2003. The vast majority of artificial joint replacements are very successful. Over time, the artificial joint may loosen and become unstable, requiring revision (re)surgery, but 85-90% of patients still have excellent function 20 years after surgery.
The increasing number of younger, more active patients undergoing artificial joint replacement surgery in recent years and the longer life expectancy of older adults have made it a challenge for physicians and the orthopaedic industry to make the life cycle of artificial joint replacement surgery ever longer.
Advances in surgeon technique and in the quality and instrumentation of artificial joint prostheses have helped to increase the success rate of surgery, and improvements in materials such as titanium and ceramic prostheses, new plastic joint liners, and the use of computer-assisted navigation systems have given joint surgeons the opportunity to make prostheses work even longer in the human body.
Preoperative Preparation for Artificial Joint Replacement Surgery.
Pre-operative preparation will begin several weeks before the artificial joint replacement surgery is performed, and the surgeon will tell the patient.
? Store their own blood: some people will need it.
? Muscle strength exercises for the upper/lower extremities under medical supervision.
? Performing a full-body physical examination.
? Performing an oral examination.
? Stop taking certain medications: e.g. anticoagulants.
? Stopping smoking.
? Controlling weight.
? having a meeting with the surgeon, anesthesiologist, nurse, and rehabilitation therapist.
? Performing routine laboratory tests.
? Assessing what you will need at home when you return home after surgery.
VII. Prevention of possible surgical complications.
The incidence of complications after artificial joint replacement surgery is very low, and the incidence of serious complications such as joint infection is less than 1%. However, as with any major surgery, patients undergoing artificial joint replacement surgery are still at risk for complications, most of which can be successfully avoided and treated, and possible complications include
? Infection: Infection can occur both in the wound and around the new joint. Infection can occur during hospitalization, after the patient goes home, or years later.
? Blood clots: Blood clots can occur for many reasons, such as reduced blood flow due to decreased patient activity after surgery.
1. taking medications that thin the blood flow (anticoagulants).
2.Wearing elastic stockings to improve blood circulation in the legs.
3. using inflated elastic boots to help improve blood circulation
4. elevating the legs and lower limbs helps blood return.
5.Do muscle contraction and diastole exercises regularly and walk regularly early after surgery.
? Pneumonia: Pneumonia is a common risk after various major surgeries. To prevent the occurrence of pneumonia, patients should practice doing deep breathing exercises and practice active coughing.
VIII. Surgical situation
Each hospital has its own unique procedures, but patients who undergo artificial joint replacement surgery their surgical experience is roughly the same as the following.
? Arrival at the hospital at the appointed time.
? Completion of the admission procedure.
? Performing the final preoperative assessment of vital signs and general health status.
? Meeting with the anesthesiologist and surgical nurse.
? Opening intravenous access for rehydration and drip antibiotics.
? Transport to the operating room.
? Artificial joint replacement surgery, which usually lasts 1-2 hours.
? admission to the recovery room.
? monitoring vital vitals until stable.
? Returning to their own beds.
? Observation of vital vitals and wound dressings.
? Routine postoperative laboratory tests.
? Assessment by rehabilitation therapists.
? Consumption of clear liquids or soft meals.
? Start doing the post-operative rehabilitation activities taught by the surgeon during the pre-operative visit.
Recovery in hospital (10-14 days) – ® Significant functional improvement (6 weeks-3 months) – ® Maximum functional improvement (6-12 months)
After surgery the joint surgery specialist, nurses and rehabilitation therapists will continue to closely monitor your condition and recovery. You will spend a lot of time practicing using the artificial joint and performing deep breathing, active coughing exercises to prevent pneumonia, pain medications will be tapered, IV tubes will be removed, diet will gradually become dry/hard, and activity will increase.
Patients who have had artificial joint replacement surgery can be discharged when they reach a certain stage of rehabilitation such as being able to get up/lie in bed or walk up to 100 steps without assistance. Depending on your doctor’s assessment of your abilities, it will be determined whether you will go straight home or go to the rehabilitation unit for further rehabilitation.
Get moving again
It may surprise you to learn that doctors encourage patients who have had artificial joint replacement surgery to get up and start moving as early as possible, even on the day of surgery.
Physical therapy is a central part of rehabilitation. The sooner a patient is active after joint replacement surgery, the faster he or she will regain independence.
X. Life after artificial joint replacement surgery
The vast majority of patients (over 95%) experience a significant reduction or even elimination of joint pain and a significant increase in their ability to participate in daily activities after the artificial joint replacement surgery, however, the artificial joint replacement surgery does not in any way leave you with a better natural joint than you had before the problem occurred.
Each patient will have some restrictions on their activities for a few weeks after the joint replacement surgery, using crutches or a walker for a few weeks, no kneeling, bending or jumping exercises for the first month, and no driving a car for 6 weeks.
After complete recovery, most patients will return to work, but there are some jobs that are not suitable after artificial joint replacement surgery, such as construction, lumbering, shipping, etc. Also, activities that can cause high compressive stress on the joint after artificial joint replacement surgery, such as ice skating, basketball, soccer and other rival sports, long-distance running and jumping, should be avoided.
Acceptable activities after artificial joint replacement surgery should be.
? Not cause joint pain, including pain felt later.
? not vibrate the joint such as occurs when running or jumping.
? do not place the joint at the limit of the joint’s range of motion.
? should be pleasant rather than painful.
Patients undergoing artificial joint replacement surgery must keep their weight as normal as possible [body mass index = weight (kg)/height (m)2 21-23], joint wear and loosening will increase with weight gain.
XI. Talk to your doctor
If medications and other conservative treatments do not provide adequate and effective relief of your joint pain, artificial joint replacement surgery will provide you with lasting pain relief and restore your desired activities. Take note of your joint pain, your expectations and the benefits of joint replacement surgery for you, talk to your surgeon and take note of his or her explanations and advice.
It is important to remember that even if your joint surgeon determines that joint replacement surgery is an excellent treatment for you, the final decision is yours, because the joint pain is in your body. The ultimate goal is to make you as comfortable as possible, and that always means making the best decision for your individual needs.
You don’t have to live with joint pain, you can be perfectly healthy and happy!