Clinical manifestations of osteoarthritis of the knee: Osteoarthritis of the knee is a common chronic degenerative joint disorder in middle-aged and elderly patients, with an incidence of about 6%. The prevalence is as high as 90% in older people over 65 years of age, of whom about 60% have symptoms. Osteoarthritis is a group of diseases that cause symptoms and signs due to wear and tear of joint cartilage, commonly known as osteoporosis. The most common symptom is pain, and the pain is activity-related, starting with activity pain and continuing with pain, and in the late stages, nighttime pain and even waking up in pain. In addition, joint swelling, deformation, restricted movement, and the disability rate is quite high, even affecting the quality of life of the elderly. Pain: persistent dull pain, joint movement may be limited by pain. Joint stiffness and adhesion: stiffness when standing up after sitting for a long time. Joint interlocking: The joint suddenly becomes stuck at a certain angle and cannot be extended or flexed, usually taking a long time to regain function. Swelling of the joint: May be accompanied by increased local temperature, fluid accumulation and synovial hypertrophy. Bouncing of joint movement (bone rubbing sound): may be due to cartilage loss and poor joint finish. Joint deformity: Patients with advanced knee osteoarthritis often develop internal and external knee deformities, commonly referred to as “rotundity” and “X-leg”. The treatment of osteoarthritis of the knee: general treatment and drug therapy: general therapy: rest, immobilization, physical therapy, can not stop and reverse the process of disease, but can delay the postponement of surgical treatment. Drug therapy: divided into systemic and local drugs to improve symptoms and reduce joint pain and joint mobility, there are non-steroidal anti-inflammatory drugs, chondroprotective agents, intra-articular injection of sodium hyaluronate, etc.. They can only relieve the symptoms and slow down the progress of the disease, but cannot reverse the structural joint lesions. Arthroscopic treatment: It has a diagnostic and therapeutic role and is of value for patients with early mild osteoarthritis, especially those with free bodies and limited cartilage damage. Degenerative articular cartilage is the most predominant lesion in knee osteoarthritis. Arthroscopic treatment of degenerative cartilage can be divided into 5 degrees, and arthroscopic treatment needs to be targeted according to the different pathological changes: for small areas (less than 3 cm2) of 1st and 2nd degree degenerative cartilage, chondroplasty alone can be done; for small areas of 3rd and 4th degree degenerative cartilage, chondroplasty plus drilling can be done; for severe large areas (>3 cm2) of degenerative cartilage, chondroplasty alone can be done; for severe large areas (>3 cm2) of degenerative cartilage, chondroplasty alone can be done. For severe degenerative cartilage lesions (larger than 3 cm2), chondroplasty alone is performed, and if the cartilage lesion is combined with subchondral bone cystic lesions, drilling can be performed routinely. At the same time, the hyperplastic bones should be actively treated and the bones that affect the function should be removed as much as possible Artificial joint replacement: can be applied to shoulder, elbow, wrist, interphalangeal, hip, knee and ankle joints, etc., but total artificial hip and knee joint replacement is the most common. Most artificial joints are made of metal and high-density polymer materials that follow the structure, shape and function of human joints. Arthroplasty is the removal of the worn and damaged joint surface and the implantation of an artificial joint like a dental brace to restore a normal smooth joint surface. For patients with end-stage osteoarthritis, prosthetic joint replacement is the way to preserve joint function, improve joint deformity, and enhance quality of life. More and more patients with severe knee disease are now receiving surgical treatment with artificial knee replacements, and their surgical techniques are quite mature. At present, minimally invasive total knee replacement is carried out, and the surgical incision is 1/3 to half smaller, which reduces the damage to soft tissues, speeds up the rehabilitation process, and achieves satisfactory results. A large number of patients suffering from rheumatoid arthritis, systemic lupus erythematosus, scleroderma and other concurrent severe joint lesions have been treated with artificial joint replacement surgery, regaining the vitality of their joints and restoring their quality of life and confidence. Third, the surgical efficacy of artificial joint replacement and the life of the prosthesis: artificial joint is one of the most important advances in the field of orthopaedic surgery in the twentieth century, at present, artificial joint replacement has become the main means of treatment of serious joint pathologies, known as an important milestone in the history of orthopaedic development in the twentieth century. Artificial total knee arthroplasty is considered one of the most effective and successful procedures for the treatment of end-stage or severe knee arthritis. The long-term follow-up results of primary total knee replacement are encouraging: the success rate of the procedure is 95 to 98%. In some developed countries, a large number of patients undergo artificial total knee replacement each year. Currently, the number of artificial knee replacements has surpassed that of hip replacements. After decades of development, knee arthroplasty is now a relatively mature orthopedic surgery with certain procedural rules and patterns of operation. However, the procedure requires a high level of skill on the part of the surgeon performing the procedure. At the same time, the position of the artificial knee joint and the balance of the soft tissues around the joint have a great influence on the outcome of the surgery. Total knee arthroplasty (TKA) is developing rapidly. As the surgical technique has matured and the design of the knee prosthesis, materials and related instruments have been refined and improved, the clinical results have continued to improve. Currently, the prosthetic survival rate is over 95% for 10-15 years after total knee arthroplasty, and the average survival period is about 20 years. The most used total knee prosthesis at home and abroad is the total condylar prosthesis, and the fixation method is mostly bone cement fixation. The metal part of the knee prosthesis is composed of cobalt-chromium-molybdenum alloy and titanium alloy, and the non-metal part is polyethylene. Fourth, artificial joint replacement patient misconceptions: the United States each year to perform total knee replacement of more than 200,000 cases, while China’s 1.3 billion population each year only less than 20,000 cases of total knee replacement. The reason for this is that in addition to the economic gap, the main reason is the gap in science education. Many patients and even some doctors are not aware of the efficacy of artificial knee replacement and are skeptical that osteoarthritis of the knee can be eliminated by artificial joint replacement and improve function. With the development of our society and economy, the pursuit of quality of life, and the popularization of artificial knee replacement theory and technology, we believe that more and more patients with osteoarthritis will undergo joint replacement surgery. 1. Does the artificial joint remove the entire joint? Patients do not know much about artificial joints, and often think that the entire joint will be removed during surgery and fitted with a stainless steel joint, so the limb is as stiff and unnatural as a robot after surgery. In fact, artificial joint replacement surgery is only the removal of the worn and damaged joint surface, just like the implantation of braces, so that the normal smooth joint surface is restored. 2. Is it painful and unbearable after surgery? Artificial knee replacement surgery is a systemic surgery, and experienced surgeons will consider the post-operative pain of the patient carefully, in addition to completing the surgery well. Normally, I give my patients an intravenous pain pump after surgery. This pain pump can be used 24 hours a day to provide pain relief from the intravenous pain medication. As we all know, the 3 days after surgery is the peak period of pain, because of the use of the pain pump patients can basically relieve the pain, will not endure severe post-operative wound pain, after 3 days will also take some oral pain medication in order to carry out joint rehabilitation exercises, patients in the post-surgery hospitalization period we will carefully analgesic treatment, so that patients do not suffer from pain during recovery 3, artificial joint replacement is worth doing? Patients who have to bear part of the cost of surgery for artificial joints, is it worth the money? Many patients saw the good results after the surgery from concern and fear to gradually received this surgery, and after the surgery many patients told me from the bottom of their hearts: “the worry and fear and all kinds of concerns before the surgery is really superfluous, so that because of the fear of surgery and suffered for many years, and even seriously affected the daily life”. I also often ask patients after surgery, especially older patients, “Is this knee replacement surgery worth it and what are the results?” They almost always answer me with a smile, “It’s worth doing, it’s worth doing, I would have done it a long time ago if I had known it was like this”. Fifth, the choice of artificial joint replacement prosthesis: choose domestic or imported prosthesis? Is the price the better? Is there a relationship between the price of the prosthesis and the post-operative joint mobility? 1, in the artificial joint replacement, the application of prosthesis is an indispensable link. However, in the nearly 10,000 cases of artificial knee replacements completed in China, most of the prostheses come from foreign manufacturers. At the meeting, experts raised some hopes for domestic prostheses. Experts believe that most domestic prostheses are imitation products with low technical content, while the price is still high, there are not many varieties to choose from, and the quality needs to be improved. Experts called on domestic manufacturers to increase their efforts in product development, in order to occupy a place in the huge market of artificial joint prostheses. 2, clinically, after receiving artificial knee joint replacement surgery patients, the range of motion of the knee joint is not the same. There are a variety of factors that affect the range of motion of the patient’s knee after this surgery, and these factors come from the patient, the prosthesis, and the surgeon performing the surgery. The patient’s preoperative range of motion is the most important factor: if the patient has a large preoperative range of motion, the postoperative range of motion will be reduced; if the preoperative range of motion is small, the postoperative range of motion will be increased. The correct choice of prosthesis is also an important factor in determining a patient’s postoperative range of motion. Some surgeons choose an improper prosthesis during surgery – either large or small – which can affect the patient’s post-operative joint range of motion. 3. For severe osteoarthritis without obvious activity impairment, no obvious inversion deformity, and good joint stability, a prosthesis that preserves the posterior cruciate ligament can be applied; for osteoarthritis patients with joint flexion dysfunction and obvious deformity, but no lateral instability, a posterior stable prosthesis can be selected; for severe lateral instability or severe deformity, a rotating hinge knee should be selected when the lateral collateral ligament cannot be preserved during surgery. The choice of prosthesis for knee osteoarthritis needs to be based on the patient’s type and degree of osteoarthritis, the patient’s age, the degree of cartilage degeneration, joint deformity and joint stability, the patient’s general condition and the patient’s economic situation. VI. Post-arthroplasty rehabilitation: The functional training of patients after receiving an artificial knee replacement cannot be done slowly – the patient should be allowed to perform appropriate exercises passively before he/she wakes up from anesthesia. If the patient does not move off the floor 5 days after surgery, this can have a serious adverse effect on the patient’s joint function.