What Is Arthroplasty?

Artificial joint replacement refers to the use of metal, polymer polyethylene, ceramics and other materials to make artificial joint prostheses according to the shape, structure and function of human joints, which are implanted into the human body by surgical techniques to replace the function of diseased joints to achieve relief Joint pain, the purpose of restoring joint function.

Basic Information

English name

prosthetic replacement of joint

Visiting department

orthopedics

At present, knee replacement and hip replacement are the two most common types of surgery in artificial joint replacement. Their 10-year success rate has exceeded 90%, and more than 80% of patients can normally use implanted prostheses for up to More than 20 years, even with its lifetime. In addition, shoulder, elbow, and ankle joint replacements are also continuously developing, and good mid- and long-term results have been achieved. With the advancement of biomaterials and surgical techniques, facet joint replacements such as wrist, interphalangeal, and metatarsophalangeal joints have gradually appeared, bringing hope to patients with severe facet joint diseases.

Indications for artificial joint replacement

Artificial joint replacement is used to treat end-stage joint disorders.

1. Severe osteoarthritis.

2. Rheumatoid arthritis, traumatic arthritis, ankylosing spondylitis, arthritis or joint pain caused by congenital developmental malformations, motor dysfunction, Paget disease, and tumors of bones and joints.

3. Patients with the above diseases still need to meet the following criteria to be suitable for artificial joint replacement:

(1) Imaging changes of articular surface bone and cartilage destruction;

(2) moderate to severe persistent pain;

(3) After at least half a year of conservative treatment, the function and pain cannot be improved. Conservative treatment should at least include: non-steroidal anti-inflammatory drugs and other types of pain medications, physical therapy, walking aids (cane, crutches, etc.) and conscious changes in life and work habits to reduce joint load;

(4) The patient can actively cooperate with the doctor for treatment and has good compliance.

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 immature surgical techniques, it was thought that artificial joint replacement was only suitable for people over 65 years of age. However, as more new wear-resistant materials are widely used in artificial joints, surgical techniques, especially revision techniques, have greatly improved, and the design of various revision prostheses has become more and more perfect, and people's requirements for quality of life have continued to increase. More and more elderly people and young people undergo artificial joint replacement for severe joint disease.

Success factors for artificial joint replacement

1. Must choose patients with appropriate indications

Although artificial joint replacement has achieved great success, it is still difficult to meet the requirements of young patients with large amounts of activity and long-term use; for some elderly patients, it is accompanied by severe diseases of other organs, or it is difficult to cooperate with doctors for early joint Functional rehabilitation is not suitable for joint replacement. Ensuring patient safety is always the first issue to be considered in artificial joint replacement.

The patient must have a general condition and a good mental state to meet the requirements of the operation, and at the same time have reasonable expectations for artificial joint replacement.

2. Surgical technique

Artificial joint replacement requires a high degree of technical skill in the operation of the doctor.

First of all, in addition to the removal of the joint lesions in artificial joint replacement, it is necessary to deeply understand the kinematics of the joint, and to install the prosthesis of the artificial joint in an accurate position, which can not only achieve good stability of the prosthesis, but also Restore normal motion of the joints. Secondly, a large number of tools and instruments are used in artificial joint replacement. Doctors must master the design principles of tools and instruments and be familiar with the use methods. This requires a lot of theoretical study and clinical practice. In China, there is also a feature that when most patients seek joint replacement, joint disease has reached advanced stage, and there are severe joint deformities and bone defects. This requires doctors to have a solid theoretical foundation and rich clinical experience to be able to flexibly handle the complex situations that arise during surgery.

3. Prosthesis selection

Many patients simply understand that artificial joint prostheses are "the more expensive the better, the newer the better."

In fact, first of all, artificial joint prostheses need to be effective in the human body for a long time, and new prostheses are often only simulated tests in the laboratory. Although the experimental data show that it can be used for a long time, due to the extremely complicated human environment, it is questionable whether the joint prosthesis can exert long-term efficacy in the human body and it takes time to test.

Secondly, there are many types of artificial joint prostheses. The designed anatomical data comes from people of different races. The original intention is to target patients with different types of diseases. Therefore, expensive prostheses and new prostheses may not be the most suitable prosthesis for you.

Furthermore, the degree to which doctors are familiar with the prosthesis also largely determines the clinical outcome. A new prosthesis may have just entered clinical use. Doctors also lack practical experience and may not be familiar with the characteristics of the prosthesis. Familiar, it will prolong the operation time and increase postoperative complications.

4. Perioperative management

The success of an artificial joint replacement was the result of a team working together. Surgeons play a major role, and anesthesiologists, physicians, nurses, rehabilitators, etc. are equally important and indispensable. Artificial joint replacement in developed western countries is very mature, so a stable team has been formed in the medical center of artificial joint replacement, and standardized treatment procedures are adopted for patients who need artificial joint replacement. This greatly improves the safety and success rate of the operation, shortens the length of stay of the patient and reduces the medical expenses of the patient.

Perioperative management involves the evaluation of the patient's general body condition before surgery, anesthesia evaluation and operation, the skilled cooperation of the surgeon and the equipment nurse during the operation, postoperative pain relief, anti-infection, and rehabilitation.

All four elements of successful artificial joint replacement are indispensable.

Effect of artificial joint replacement

The main purpose of artificial joint replacement is to relieve joint pain, correct joint deformities, restore joint function, and improve the quality of life of patients.

As a substitute for organs, artificial joints inevitably have problems of wear and failure, but modern artificial joint prostheses have been able to achieve good long-term survival rates. The National Institutes of Health (NHS) in the United Kingdom has proposed standards for artificial joint replacement surgery, which means that the success rate of at least 90% in ten years is called the NICE standard. In clinical practice, a large amount of data has been shown that through good surgical techniques, the appropriate artificial joint prosthesis is selected. With the full cooperation of the patient, the 20-year excellent rate of artificial joint replacement, especially knee and hip replacement, can be More than 90%.

After artificial joint replacement, patients can return to normal working life and social activities. In addition to violent antagonistic activities that doctors cannot or do not recommend, patients can perform activities such as running, swimming, badminton, golf, cycling, Horse riding, dance, Tai Chi and other sports.

Complications of artificial joint replacement

The common complications of artificial joint replacement can be divided into several aspects, some of which are related to the patient's disease and their own physical conditions, some are related to the surgical operation of the doctor, some are related 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 are:

1. Artificial joint prosthesis is loose.

2. Mechanical failure of artificial joints, such as dislocation, wear, failure of locking mechanism, fracture of prosthesis, etc.

3. Deep vein thrombosis and pulmonary embolism.

4. Periprosthetic infection after artificial joint replacement.

5. Postoperative nerve injury, vascular injury, fracture around the prosthesis.

6. Joint instability and stiffness after artificial joint replacement.

7. Pain after joint replacement.