Text/Lin Xinping
Many elderly mothers-in-law go up and down stairs, mop the floor and buy food every day. As long as they walk a little, their knees can't stand it. After examination, they were found to have degenerative arthritis. No matter recovery, taking medicine or injection, the symptoms are getting worse and worse, and the artificial knee joint has to be replaced by surgery.
Many people are worried about whether they will walk with an artificial joint "Kaka" and whether their knees will not recover as they did when they were young. Chen Weiming, director of the Department of Joint Reconstruction of Orthopedics at Taipei Rongzong and professor of orthopedics at Yangming Medical College, said that although you can squat, run and jump after knee surgery, you should try to avoid hurting your knee because of the heavy burden of squatting and kneeling on the ground. Except for running for life in an emergency or going out to the toilet without a toilet, you can squat while running at this time, so as not to accelerate the deterioration of joint wear and reduce the service life of artificial joints.
Every year, 20,000 people replace their knees.
When people are active, the joint bending angles required for different actions are also different. Generally speaking, the average knee bending angle is 67 degrees when walking, 90 degrees when going up and down stairs, 65,438+006 degrees when picking things up on the ground, and 65,438+035 to 65,438+045 degrees when squatting, kneeling, running and jumping.
But knees are like car tires. If it is used for a long time, the tire skin will wear out. Because the average life expectancy of China people is prolonged, especially the average life expectancy of women is 82.6 years, the knee joint is easily overwhelmed after years of use. Once people take painkillers, conservative treatments such as rehabilitation are ineffective, and their joints are seriously degraded, which has even affected their daily lives. If they are over 60 or 65, they may consider replacing artificial joints.
95% of the cases receiving artificial joint replacement are caused by degenerative arthritis; 4% is rheumatoid arthritis, which destroys joints due to autoimmune problems; The remaining 1% is caused by other diseases, and the clinical situation in China is similar to that reported in the United States. It is worth noting that only a few gout patients need to replace artificial joints, and most patients can control uric acid through drug treatment.
At present, Taiwan Province Province receives about 20,000 cases of knee replacement every year, and the United States has reached more than 400,000 cases, with an increase of about 84% from 1.998 to 2009. The growth rate in Chinese mainland is also quite alarming, with the number of cases of artificial joint replacement soaring by 30% every year.
Most of them are female patients.
"About 78% of knee replacement cases are women. Women's knees are more prone to problems than men's, mainly for four reasons:
Phase 1: Due to menopause, a large number of female hormones are lost, which leads to accelerated metabolism of cartilage and bones and accelerated joint degeneration.
Second: Generally speaking, women's exercise is not as good as men's, thigh muscles are not as strong as men's, and articular cartilage has to bear more weight and pressure, which leads to increased knee joint wear.
Thirdly, from the perspective of physiological anatomy, women are born with smaller bones, but the physiological structure of the family makes women's congenital pelvis wider, which leads to the large angle connection between the patellar tendon and quadriceps femoris of the thigh and the pelvis, which makes the patella originally located in the center of the knee joint deviate, which increases the lateral wear of patellar cartilage and affects the health of the knee joint.
Fourth: Oriental women always think that white skin is beautiful. Most people don't like basking in the sun, but wear high heels. Once middle-aged people get fat and lose their shape, high-heeled shoes have poor shock absorption, and all the pressure is placed on the knee joint, which will also increase joint wear.
Some people are not suitable for replacement.
At present, Taipei Rongzong mostly adopts minimally invasive technology. Usually, the process of joint replacement surgery is less than 1 hour. Minimally invasive method can minimize soft tissue injury, and patients have less trauma and quick recovery.
However, there are also taboos in artificial knee replacement surgery. If a person has a stroke for less than half a year; Or not long after myocardial infarction, there will usually be chest tightness symptoms. It is recommended to go to neurology and cardiology for stroke assessment and cardiovascular examination to confirm that blood pressure is stable and the cardiovascular system is not blocked. Only in this way can joint replacement be performed. In addition, if you have a urinary tract infection or an infectious wound on your skin, you must cure the infection before you can operate, so as to prevent bacteria from running through the blood to the joints and causing infection, and even take out the artificial joints.
Infection is the most feared condition in knee replacement surgery, followed by the fracture near the joint caused by falling. These conditions will affect the life and function of artificial joints. In addition, venous embolism also needs to be prevented. High-risk patients, such as overweight (body mass index > 30) or patients with a history of embolism, should use anticoagulants after operation, such as low-molecular-weight heparin and aspirin, in order to avoid blood clots from reaching the lungs and endangering their lives.
Medical insurance payment materials are enough.
Beirong used general health insurance payment materials to track patients who underwent artificial knee joint surgery for more than 65,438+05 years, and found that only a few people needed to replace their joints again. "Most patients' joints can be used for at least 65,438+05 years or a lifetime. Chen Weiming said that unless the patient is young, less than 65 years old, usually active, and the body mass index (weight divided by the square of height meters) exceeds 30 (inclusive), it is recommended to use self-funded wear-resistant gaskets.
A study in the United States in 2009 pointed out that nearly 5% of people over 50 have at least one artificial knee joint, and the number of people over 80 is as high as 10%. Considering the life span of joints, research shows that 80% people can have artificial joint surgery for at least 20 years. Therefore, health care materials are sufficient for most patients.
Avoid strenuous exercise after operation.
Do you need rehabilitation after artificial knee replacement? Chen Weiming said, "Most people don't need it. Walking is recovery. If the patient only changes one knee joint, he doesn't even need crutches after surgery; It only takes about 1 week to use a knife with both feet. He stressed that the thigh muscles should be well trained after operation. When the quadriceps femoris is stronger, it can disperse the stress on the joint and increase the protection of the knee joint. It is suggested that leg lifting every day can not only exercise thigh muscles, but also reduce the chance of venous embolism.
Besides walking, swimming is also a very good rehabilitation exercise, because the buoyancy of water can avoid joint wear; In addition, patients can ride bicycles, climb mountains, climb mountains, play golf, dance folk dances, play table tennis and tennis. But remember that the nature of the activity is mainly leisure and entertainment, rather than participating in fierce competitive competitions; If you climb a mountain, remember to use a trekking pole. If you climb a mountain, you'd better find someone to help you carry your backpack, so as not to increase the wear and tear of the artificial joint.
In addition, you can use the strength of a good foot (normal foot) to press on the upper part of the joint surgery leg and hook it inward to the body; Or kneel on a quilt, a soft sofa or a pillow, and use the weight of the upper body to increase the flexion and mobility of the knees.
"Ice can reduce swelling and relieve pain. Chen Weiming said that about 3-6 months after the operation, the knee joint will have slight swelling and slight fever. It is recommended to pack more ice in the first half of the year. In addition, if you want to go a long way, you can wear air cushion shoes, sports shoes or casual shoes to reduce joint wear.
Control weight and reduce the burden of knee joint.
You can eat anything after operation, but don't eat fat. Overweight will increase the joint burden, so people with poor knees should control their weight to avoid the wear and tear of the weight-bearing joints and affect the service life of the artificial joints. However, clinical observation shows that most patients' weight does not drop but rises after operation, mainly because they can move freely after replacing the artificial joint, so they are in a good mood, travel everywhere, eat and drink, and lack exercise, which leads to their weight rising linearly.
In addition, many people often eat health foods such as shark cartilage or glucosamine to maintain their bones and knees. At present, large-scale international studies, including Switzerland, the United States and other developed countries, show that there is still no evidence to support the consumption of such health food to treat degenerative arthritis, and its effect is still controversial, especially shark cartilage and animal protection, so it is not encouraged to spend a lot of money to buy it.
Two weeks after knee surgery, the patient should return to the clinic to let the doctor check the swelling and healing of the wound, and know whether the nursing of the affected part, knee rehabilitation and leg muscle training are good. "Walking is rehabilitation, and joint mobility can be adjusted by itself. Chen Weiming said that the range of motion of the joint should be greater than 65438 035 degrees without crutches for half a month after operation. 6X 1X after operation