I. Introduction to Artificial Joint Replacement Artificial joint replacement refers to the use of metal, polymer polyethylene, ceramic and other materials, according to the form, structure and function of human joints to make artificial joint prosthesis, through surgical techniques implanted in the human body, to replace the function of the diseased joint, to achieve the purpose of relieving joint pain and restoring joint function. Artificial joint replacement is one of the most successful orthopaedic surgeries of the 20th century, allowing countless patients with end-stage bone and joint disease to resume a normal life. Although exact statistics are not available, it is conservatively estimated that more than 1.5 million people worldwide receive artificial joint replacements each year. With an aging population, increasing average life expectancy, and improving quality of life, the demand for artificial joint replacement continues to grow. This demand is even more pronounced in China. Currently, knee and hip replacements are two of the most common types of artificial joint replacements, with a success rate of more than 90% over 10 years, and more than 80% of patients are able to use the implanted prosthesis for more than 20 years, even for the rest of their lives. In addition to these, joint replacements of the shoulder, elbow, and ankle joints are also evolving, with good medium- and long-term results. With the advancement of biomaterials and surgical techniques, small joint replacements such as wrist, interphalangeal and metatarsophalangeal joints have emerged one after another, bringing hope to patients suffering from serious small joint diseases. Indications Artificial joint replacement is used to treat end-stage joint disorders. (1) Severe osteoarthritis; (2) Rheumatoid arthritis, traumatic arthritis, ankylosing spondylitis, congenital developmental malformations resulting in arthritis or joint pain and dysfunction, Paget’s disease, and tumors of the bone and joint; (3) Patients with these diseases must also meet the following criteria to be eligible for arthroplasty: (1) imaging changes of bone and cartilage destruction of the joint surface. (2) Moderate to severe persistent pain; (3) Failure to improve function and pain after at least six months of conservative treatment. Conservative treatment should include, at a minimum, non-steroidal anti-inflammatory drugs and other types of pain medications, physical therapy, mobility aids (canes, crutches, etc.), and conscious changes in lifestyle and work habits to reduce joint loading; (4) The patient is able to actively cooperate with the physician and has good compliance with treatment; (4) Age is no longer a decisive factor in artificial joint replacement. Initially, due to the limitations of the early artificial joint prosthesis design and material wear performance, as well as the immaturity of the surgical technique, artificial joint replacement was once thought to be only applicable to people over 65 years old. However, as more new wear-resistant materials were widely used in artificial joints, surgical techniques, especially revision techniques, were greatly improved, the design of various revision prostheses became more and more perfect, and people’s requirements for quality of life continued to improve, more and more senior people and young people underwent artificial joint replacement because of serious joint diseases. (1) (Patient Selection) Patients with appropriate indications must be selected Artificial joint replacement, despite its success, is still difficult to meet the requirements of young patients with high activity and long-term use; for some elderly patients with serious diseases of other organs or difficulties in cooperating with doctors for early joint function rehabilitation, it is also not suitable for joint replacement. For some elderly patients, who have serious disorders of other organs or who have difficulty cooperating with their physicians for early joint rehabilitation, joint replacement is also not suitable. Patient safety is always the first consideration in prosthetic joint replacement. The patient must be in good general and mental condition to meet the requirements of the procedure, and must have reasonable expectations for the arthroplasty. (2) (Procedure) Surgical technique Artificial joint replacement requires a high level of surgical technique from the surgeon. First of all, in addition to the removal of the joint lesion, the artificial joint replacement requires a deep understanding of the kinematic principles of the joint and the installation of the artificial joint prosthesis in the exact position, so that the prosthesis can obtain good stability and restore the normal movement of the joint. Second, a large number of tools and instruments are used in prosthetic arthroplasty. The surgeon must master the design principles of tools and instruments and be familiar with their use, which requires a lot of theoretical study and clinical practice. Another characteristic in China is that most patients seeking joint replacement have advanced joint disease with severe joint deformities and bone defects. This requires a solid theoretical foundation and extensive clinical experience in order for the surgeon to be flexible enough to handle the complexities that arise during surgery. Overseas studies have shown that patients treated by surgeons with less than 30 surgeries per year are more likely to have complications. (3) (Prosthesis Selection) Prosthesis selection Many patients simply understand that artificial joint prosthesis “the more expensive the better, the newer the better”. This is not true. First of all, artificial joint prostheses need to perform for a long time in the human body, and new prostheses are often only tested in simulations in the laboratory. Although the experimental data show that can be used for a long time, but because the human environment is extremely complex, joint prosthesis can play a long-term performance in the human body is in doubt, need time to test. Secondly, there are many different types of artificial joint prostheses, which are designed with anatomical data from different ethnic groups and are intended for patients with different types of diseases, so an expensive prosthesis or a new prosthesis may not be the best one for you. In addition, the doctor’s familiarity with the prosthesis also largely determines the clinical outcome. A new prosthesis, which may have just entered clinical use, the doctor still lacks practical experience and may not be familiar with the characteristics of the prosthesis, which in turn may prolong the operation and increase post-operative complications. Therefore, it is more accurate to understand that “there is no best prosthesis, only the most suitable prosthesis for you. (4) (Peri-operation Management) Peri-operative Management The success of a prosthetic joint replacement is the result of a team effort. While the surgeon plays a major role, the anesthesiologist, internist, nurse, and rehabilitator are equally important and essential. Arthroplasty in the Western world is so well established that a stable team has been formed in the medical center for artificial joint replacement, and a standardized procedure is used for patients requiring artificial joint replacement. This has greatly improved the safety and success rate of the procedure, shortened the patient’s hospital stay and reduced the patient’s medical expenses. Perioperative management involves preoperative assessment of the patient’s general condition, anesthesia evaluation and operation, skilled coordination between the surgeon and instrumentation nurse during surgery, postoperative pain relief, anti-infection, and rehabilitation. One of these four elements is essential for a successful prosthetic joint replacement.