Artificial joint replacement refers to the use of metal, polymer polyethylene, ceramic and other materials to make artificial joint prostheses according to the shape, structure and function of human joints, which are surgically implanted into the human body to replace the function of the diseased joint and to relieve joint pain and restore 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. Operation of The Century.) Although exact statistics are not available, conservative estimates suggest 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 advances in biomaterials and surgical techniques, small joint replacements such as wrist, interphalangeal, and metatarsophalangeal joints have emerged one after another, offering hope to patients suffering from severe small joint disease. History Prior to the advent of artificial joint replacement, medical doctors never stopped exploring the treatment of joint diseases. Resection, Arthrodesis, Osteotomy, Arthroplasty, and Amputation have been widely used in the treatment of joint disease, and some are still used in specific patients today. However, most of these procedures were performed at the expense of joint function and reduced the quality of life of the patient in order to resolve joint pain and treat joint disease. In the late nineteenth century, Dr. Themistocles Gluck of Berlin, Germany, after a series of animal experiments that confirmed the acceptability of foreign implants in humans, first made knee prostheses from Ivory in patients with joint tuberculosis and then fixed them in the knee joint with a mixture of Resin and Plaster of Paris. in the knee joint. In modern terms, it is clear that this joint would not have been successful, but it was certainly a shining starting point in the history of artificial joint replacement. The next memorable time was in 1938, when Dr. Philp Wiles from London, England, implanted acetabular and femoral prostheses made of stainless steel in six cases of Still’s disease that he treated, with the acetabulum screwed in place and the femur attached with a stem and auxiliary plate screws. Although Dr. Wiles did not continue his work due to World War II and other reasons, this became the complete prototype of artificial hip replacement. Over the next few decades, the American doctors Smith Pertersen, Moore, F. R. Thompson, Haboush, and the French Judet brothers made useful discoveries in artificial joint replacement. However, it was not until 1962, when Dr. John Charnley in England proposed the theory of low-friction artificial hip replacement, that artificial arthroplasty, especially artificial hip replacement, entered a new era. The use of polymethylmethacrylate (i.e., bone cement) for fixation of the prosthesis was the foundation for low-friction prosthetic arthroplasty. These three innovations laid the foundation for low-friction arthroplasty, which is less likely to loosen and has excellent long-term results, and the Charnley-type arthroplasty remains the gold standard for other hip replacements. Dr. Charnley continued to improve his prosthesis design and surgical technique, making the results of hip replacement predictable. Thousands of patients were soon cured of hip disease by Dr. Charnley’s treatment, and doctors from around the world came to Charnley’s hospital to learn the technique and promote it. The Queen of England honored Dr. Charnley with a knighthood in recognition of his contributions to medicine. As a result, Sir John Charnley is also known as the “Father of Artificial Joints”. After the success of metal, polyethylene, and bone cement in artificial hip replacements, scholars around the world began to design more types of artificial joint prostheses, extending them to knee, shoulder, elbow, and small joint replacements of the hand and foot. In the 1970s, Dr. John N. Insall of the United States became another giant in artificial joints. His work on the Total Condylar Prosthesis became a classic and a milestone in the design of knee prostheses. Inspired by the theory and design of the Total Condylar Prosthesis, many successful artificial knee prostheses were developed, making knee replacement a routine procedure that has brought healthy lives to millions of patients. Due to the difference in the incidence of degenerative osteoarthropathy of the knee and hip, the need for knee replacement is much greater than that of the hip. In the artificial joint replacement centers in major cities such as Beijing and Shanghai, the proportion of patients having knee replacements has exceeded 70 percent. In the 21st century, with the improvement of medical biomaterials, surgical techniques, and the intervention of medical engineering technology, artificial joint replacement is becoming more precise and minimally invasive, the success rate of surgery is greatly improved, and the long-term survival rate of the prosthesis is improving. Indications Artificial arthroplasty 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 conditions 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 living and working 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 for artificial joint replacement. Initially, due to the limitations of 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, improved the design of various revision prostheses, and people’s quality of life requirements continued to improve, more and more senior citizens and young people underwent artificial joint replacement due to severe joint disease. The elements of success (4P elements) (1) (Patient Selection) must select patients with the right indications 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, who have serious diseases of other organs or who have difficulty cooperating with the surgeon for early joint rehabilitation, joint replacement is not suitable. They are also not suitable for joint replacement. 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 Techniques Artificial joint replacement requires a high level of surgical technique. First of all, in addition to removing the joint lesion, artificial joint replacement requires a deep understanding of the kinematic principles of the joint, so that the artificial joint prosthesis can be installed in the exact position to achieve good stability of the prosthesis and restore the normal motion 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 develop 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 the laboratory in simulations. 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 an arthroplasty 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 successful arthroplasty. The main goals of artificial joint replacement are to relieve joint pain, correct joint deformities, restore joint function, and improve the patient’s quality of life. Every patient who will have an artificial joint replacement is concerned about “how many years will the artificial joint last?” This is also known as the life expectancy of the artificial joint. As an organ replacement, artificial joints are subject to wear and tear and failure, but modern artificial joint prostheses have achieved good long-term survival rates. The National Institutes of Health (NHS) in the United Kingdom has proposed a standard for artificial joint replacement that has a success rate of at least 90% over ten years, called the NICE standard. In clinical practice, there is already a lot of data showing that through good surgical technique, selection of suitable artificial joint prosthesis and with full cooperation of patients, the 20-year excellent rate of artificial joint replacement, especially knee and hip joint replacement, can reach more than 90%. This is evidenced by the artificial joint registry systems in several countries. With improvements in the design and materials of artificial joint prostheses, surgical techniques, and rehabilitation measures, there is reason to believe that artificial joint replacements will achieve even better results. After arthroplasty, patients can return to their normal work life and social activities. Patients can engage in various sports such as running, swimming, badminton, golf, bicycling, horseback riding, dancing, and Tai Chi, except for strenuous confrontational activities that are not considered or recommended by doctors. Common complications The common complications of artificial joint replacement can be divided into several areas, some of which are related to the patient’s disease and physical condition, some to the surgeon’s surgical technique, and some to the artificial joint prosthesis itself. The complications and failures that often occur in clinical work are the result of a combination of factors. Common complications include: (1) loosening of the artificial joint prosthesis; (2) mechanical failure of the artificial joint, such as dislocation, wear, failure of the locking mechanism, fracture of the prosthesis, etc. (3) Deep Venous Thrombosis and Pulmonary Thrombosis; (4) infection around the prosthesis after artificial joint replacement. (5) postoperative nerve damage, vascular damage, periprosthetic fractures; (6) postoperative joint instability and joint stiffness; (7) postoperative pain after arthroplasty. Artificial joint replacement is a relatively new technology compared to other fields of medicine, and therefore it is developing quite rapidly. Artificial joint replacement is characterized by a high dependence on high-performance materials, bionic prosthesis design, and precise and easy-to-use surgical instruments, so advances in research and new discoveries in related disciplines have led directly to advances in artificial joint replacement. In the last two decades, many new advances have been made in the field of artificial joint replacement. New materials are widely used in artificial joint prostheses, reducing wear and tear and extending the life of the prosthesis, while providing better biological compatibility. For example, Ceramic, Higher Cross linked Polyethylene, Titanium Alloy, Tantalum and other new materials are taking on an increasingly important role in the manufacture of artificial joint prostheses. The design of artificial joint prostheses is becoming more and more sophisticated, even towards individualized prostheses. Artificial joint prostheses include prostheses for initial replacement and prostheses for revision surgery. Revision surgery is often complex and requires a more demanding prosthesis with many ancillary components, and in many cases a prefabricated prosthesis will not meet the actual needs. Customized prostheses are now available that use metal 3D printing technology (e.g., Electronic Beam Melting) to quickly and precisely create a patient’s individualized prosthesis based on the patient’s preoperative CT or MRI scan. In the past, customizing a prosthesis abroad took months, delayed patient treatment, and was expensive, but now it is possible to produce customized prostheses in China, saving time and medical costs. Arthroplasty has become more precise. New technologies such as computer navigation, robotic surgery, and preoperative navigation are being used in artificial joint replacements. Several medical centers have emerged in China where the number of joint replacements exceeds 1,000 cases per year. In addition to using conventional operating techniques, these new technologies are being introduced into clinical practice, and with the assurance of skilled conventional surgery, the new technologies are being used with greater ease, resulting in better joint replacement results.