I. What conditions are suitable for knee joint replacement surgery?
(1) Various inflammatory arthritis of the knee joint, including rheumatoid arthritis, osteoarthritis, hemophilic 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.
B. 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. Based on experience, 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.
III. 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 to 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 re-examined, and every six months after that, the X-ray examination should be carried out.
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 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 material is after hundreds of wear experiments, high-quality imported artificial joints (omitted here, not advertising), generally can meet the patient more than 20 years. The current artificial joints used in clinical practice are much better than those used twenty years ago, and it is believed that more than 95% of the artificial joints placed now will continue to work after twenty years. A successful artificial joint replacement allows 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 amount of exercise the patient performs, the choice of artificial prosthesis, the surgeon’s surgical technique, and his or her own 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 perform 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 do cycling, walking, dancing, swimming and other sports, but running, jumping and other strenuous sports, as well as long-distance walking, climbing, etc. are not encouraged.
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 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 surgeon and the rehabilitator.
Even after full rehabilitation and discharge, regular rehabilitation exercises are usually required.
IX. Advantages and disadvantages of artificial knee surgery
Artificial knee surgery began in 1960, and this surgical method has been determined to be an effective procedure. 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) 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 basically 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 at a rate of 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.