Knee joint replacement surgery how to achieve good results?First, the need for knee replacement surgery?Because of knee joint diseases cause
Knee joint replacement surgery how to achieve good results?
First, the need for knee replacement surgery?
Because of knee joint diseases caused by various reasons, causing serious damage to the knee joint function of long-term pain, difficulty walking, dysfunction, serious impact on the quality of life of patients, and after other conservative treatment failed to improve, or no more effective treatment, can be considered for knee replacement. At present, the most common cause is knee osteoarthritis and rheumatoid arthritis in young and middle-aged people.
Two, knee replacement is what kind of operation? How effective?
Knee arthroplasty is an effective method for the treatment of end-stage knee joint disease, and it has become a common surgical procedure. In Europe and other developed countries, every year hundreds of thousands of cases of knee replacement, in China, since the early 90s foreign artificial joint after entering, the current annual artificial joint gradually increased, reached about 100000 cases, knee replacement surgery were similar as the European and American countries, gradually close to or exceed the number of hip replacement.
Knee replacement has experienced decades of development, maturing. However, it is different from the hip joint, especially the artificial joint inevitable wear and lack of specific biological activity organization's self repair capabilities, so the artificial knee joint is the use of age, the length of time depends on the prosthetic design, material properties, surgical technique, patients and other factors. In general, the use of 15~20 after knee replacement surgery can reach 80%~90%.
Three, do knee replacement need what conditions? The main indication of total knee arthroplasty is to relieve pain, deformity, walking difficulty and dysfunction caused by severe knee joint diseases.
1 should be excluded from diseases of the spine radicular pain, ipsilateral hip joint involved in pain, peripheral vascular disease, meniscus lesions and knee bursitis etc.. Therefore, it is necessary to find an experienced Department of orthopedics experts or joint surgery experts to conduct a detailed consultation to determine the lesions from the knee joint.
2 x ray film must be consistent with the clinical manifestations of knee joint lesions. Before considering joint replacement surgery, conservative treatment should be taken, including anti-inflammatory drugs, physical therapy, change of activity, etc..
3 knee arthroplasty absolute contraindications include: the recent knee pyogenic infection; knee extensor device is not continuous or severe loss of function; secondary to gravis recurvation and painless and good function of knee joint after fusion. The relative contraindications include: the whole body condition is bad, suffer from serious heart and liver and kidney disease, the patient has obvious arteriosclerosis. Also need joint surgery expert consultation, need comprehensive and detailed physical examination, it is necessary to fully consider the capabilities of both doctors and patients. In short, all to the patient's life safety, improve the quality of life as the starting point.
4 age: surgery on the patient's age is not an absolute limit range, currently in clinical, knee replacement patients in the general age of 55 to the age of 80, mostly between 65~78 years old. Mainly depends on (1) need to do? (2) the patient's physical condition?
Four, what needs to be done before surgery?
Because the patient is old and frail population, systemic condition should be carried out in a comprehensive and detailed assessment, in order to ensure the safety of the operation. At the same time, we should carefully check the knee joint, assess the soft tissue of the ligament, take the knee joint lateral position X piece, the patella axis X piece, the lower limb standing position X piece, understand the bone and force line situation.
Diabetes, high blood pressure, coronary heart disease, rheumatoid diseases will bring risks to the operation, therefore, preoperative need to give a good assessment and control, and please consult the relevant departments to do the appropriate treatment.
Five, knee replacement surgery do?
(1) to correct the deformity of the knee joint and restore the normal line of the lower limbs; (2) to restore the function of knee joint flexion and extension; (3) to restore the knee joint.
The specific operation steps include: surgical approach using the anterior median incision, knee joint medial and lateral soft tissue balance, reasonable osteotomy, choose appropriate prosthesis size, proper placement of femoral and tibial prosthesis, prosthesis rotational positioning reasonable, good patellofemoral trajectory. If there is a bone defect, the corresponding treatment should be done according to the defect type. Knee replacement is a highly technical operation, and the surgical experience of the doctor, the number of surgical cases each year is closely related to the need for skilled surgical techniques. Some people call it "mm Engineering", meaning that the difference of 1 mm in the operation may cause different effects, and the precision and accuracy of the operation can be seen.
Including specific surgical techniques: (1) a good line of force of the lower limbs; (2) the soft tissue balance good; (3) consistent with the flexion gap; (4) good patellar tracking; (5) to meet the requirements of the osteotomy and prosthesis placement; (6) the strict aseptic technique and minimally invasive surgery.
Six, what to do after surgery?
1 rehabilitation exercise: the completion of the operation does not mean that the effect is good, postoperative rehabilitation exercise for the effect of artificial knee replacement effect, reasonable postoperative rehabilitation guidance is very important. In general, 2~3 days after the operation can be standing, and gradually help walking. At the same time, good postoperative analgesia is essential for successful rehabilitation.
2 complications: artificial knee joint replacement potential complications include: (1) the risk of venous thrombosis and pulmonary embolism; infection; (2) (3), (4) patellofemoral complications; neurovascular complications; (5) periprosthetic fracture. Sufficient preoperative preparation, excellent surgical technique, good postoperative treatment can reduce the risk of complications to a minimum. Since the joint surgery of No.1 Affiliated Hospital of Zhongshan University from 90s to carry out knee replacement in perioperative period has not yet occurred serious complications, careful preoperative treatment is the fundamental reason, fine surgical technique and careful operation postprocessing and rehabilitation.
Osteoarthritis of the knee generally does not affect the life, do not need to rush to surgery, therefore, to adjust the physical condition, to control a variety of lesions, consult an experienced expert is needed to do before surgery. Because many of the elderly patients with chronic diseases, with the treatment needs of other departments, in order to ensure the safety, proposed joint surgery visits to the good reputation, the comprehensive strength of the hospital, not only has the specialized technology and other disciplines, strong cooperation and support, is the operation can obtain the expected effect. Total knee arthroplasty from the preoperative, intraoperative, postoperative, and rehabilitation, any details of the neglect may affect the efficacy of surgery and increase the risk of complications. Therefore, the excellent surgical technique, meticulous perioperative management and reasonable postoperative rehabilitation are the basic and basic requirements of the knee replacement.