Arthritis Care Orthopedic Surgery

Orthopedic surgery is not necessary for arthritis. Surgery is only indicated when conservative treatment (drugs, physical therapy, lifestyle adjustments) has not been significantly relieved for 6 months, the pain has affected normal sleep and daily travel, or even joint deformity has occurred.； No matter which surgical method is chosen, 70% of the postoperative recovery effect depends on the subsequent scientific care and rehabilitation, rather than the accuracy of the surgery itself. More than 60% of the cases of poor postoperative recovery in clinical practice are related to insufficient care and deviated implementation of the rehabilitation plan.

I just met a 61-year-old aunt at the outpatient clinic last week. She came in on crutches and asked for an in-patient order for a knee replacement. She said that the old sister downstairs was doing square dancing every day after the replacement, and she had wanted to do it for two years after having knee pain for two years. After I took her X-ray, I saw that the medial cartilage was slightly worn and the joint spaces were still fine. I prescribed her some topical non-steroidal anti-inflammatory drugs, taught her two quadriceps training movements, and asked her to go back and practice for a month before returning. She was not happy and said that I deliberately refused to perform surgery on her.

In fact, there are always two voices in the orthopedic community regarding the indications for surgery for arthritis. One group advocates "early intervention and early benefit". They believe that as long as the pain has significantly reduced the quality of life, surgery can be performed as early as possible without having to endure the deformity. After all, the service life of the prosthesis can now be more than 20 years. If you are 60 years old, there is a high probability that you will not need to replace it twice in your life.； The other group insists on "conservation first". After all, any surgery has the risk of infection and blood clots. No matter how easy-to-use a prosthesis is, it is not as good as your own native joint. If you can do it as late as possible, do it as late as possible. My own clinical experience is that there is no need to impose any standard. If the pain is so severe that you have to go downstairs to buy groceries, and you have tried conservatively to no avail, then do it. If you can still walk normally, but it only hurts to go up and down stairs, then there is no need to get this knife.

Don’t be afraid if you really have to go to the stage of surgery. Today is no longer the era of total joint replacement. Two months ago, we admitted a 38-year-old young man who broke his tibial plateau while playing basketball. Later, he developed traumatic arthritis. He was in so much pain that he couldn't even touch the ball. He thought he would have to deal with crutches for the rest of his life. We performed an arthroscopic cleaning and microfracture surgery on him. After staying in the hospital for three days, he went back. Now he can go back to play the second half of the amateur league. If you are between 50 and 70 years old, and only one side of the joint surface is worn out, you can also do partial replacement. The incision is small and the recovery is fast, and the body feel is closer to the original joint than a total replacement. Of course, if the entire joint is worn out and deformed, you still have to do a total replacement. The technology is now mature, so you don’t need to worry too much.

When it comes to nursing care, the first thing that many people think of is lying in bed and drinking bone soup for replenishment after surgery. This is really the biggest misunderstanding. I have seen too many patients who were not properly prepared before surgery. After three months of lying down, their muscles atrophied and their prostheses were useless no matter how good they were. I now tell patients who are about to undergo surgery in advance that they should start practicing straight leg raises one week before surgery, 100 times a day. The more familiar they are, the less they will suffer after surgery. There was a 70-year-old man who was too tired before the surgery. He had to go to the ground on the first day after the surgery and couldn't even lift his legs. When the rehabilitation therapist stretched his legs, he hit the bed in pain. It took him half a month of strength training to catch up.

The current concept of rapid recovery is to go down to the ground within 24 hours after surgery. Many patients’ families think we are too radical and say, “How can I walk just after the surgery? ”, in fact, as long as there is no obvious dizziness or wound bleeding, getting off the ground early can reduce the risk of blood clots and muscle atrophy. However, there is no need to compare with others. Some people can go to the toilet by themselves 3 days after the operation, and some people have severe osteoporosis and have to wear a brace to lie down for an extra week. There is no unified standard for this, just what suits you. I often tell patients that a newly replaced joint is like a new pair of shoes. It takes ten days and a half to break in after you put them on. You can't run a marathon as soon as you put them on, right?

There are also many people who want to weld knee braces to their legs after surgery. This is not true. Knee braces are only worn when going out for long walks or going up and down stairs. They have to be taken off when doing rehabilitation training at home. If worn for a long time, the muscles will become dependent, and the longer they are worn, the less strength they will have. Don’t think about hiking or dancing in the square just after the sutures are removed. Try to avoid heavy-bearing movements such as squatting and climbing stairs for 3 months after the operation, and slowly return to normal sports after half a year. By the way, there is also diet. Don’t just eat bone soup every day. 90% of it is fat and the calcium content is pitiful. Drinking too much will increase blood lipids and affect healing. Drink more milk, eat some boiled eggs, and dark green vegetables. The calcium supplement effect is ten times better than bone soup.

To be honest, arthritis surgery is never a "one-and-done" miracle, and nursing is not a difficult task that requires sophisticated technology. To put it bluntly, don't blindly follow other people's experience, and don't take it seriously. Follow the doctor's advice and practice slowly. After all, the joints grow on your body. Only you know best whether the joints are comfortable or not.