Arthritis Care Orthopedic Surgery

First, 80% of early- to mid-stage degenerative arthritis does not require orthopedic surgery at all. Standardized conservative care can control symptoms to a level that does not affect life.； Second, when surgery is really needed, scientific perioperative care can speed up postoperative recovery by more than 30% and extend the long-term joint lifespan by at least 5 years. The priority of care is actually higher than the surgical operation itself.

When I went out to the outpatient clinic last Wednesday, I met 62-year-old Aunt Zhang who squeezed in with three MRI reports in her hands. She rolled her trouser legs up above her knees. She pointed at the red swelling on the inside and said, "Doctor, I have been suffering from arthritis for almost three years. The clinic downstairs asked me to replace my joints quickly, otherwise I will be paralyzed in the future. Please give me a hospitalization bill." I read her report and found that the cartilage wear was only II degree, and she had no problem walking two kilometers on flat ground except for the pain when squatting. I directly prescribed sodium hyaluronate injection for her, plus a training plan for static contraction of the quadriceps muscles. I advised her to be conservative first when she went back, so as not to get that knife.

Speaking of which, the academic community has actually been arguing for almost ten years about whether arthritis should be operated on early. Conservative experts believe that the original joints are good. As long as there are no absolute indications for surgery and can be controlled by drugs, exercise, and physical therapy, surgery should never be performed. After all, any surgery carries the risk of infection and nerve damage. ； However, the views of the early interventionists are also very reasonable. If there is a clear meniscus tear, loose body stuck, or focal cartilage detachment, an arthroscopic cleaning is performed early to smooth the damaged areas. This can prevent the bad tissue from wearing out the remaining good cartilage, which will eventually lead to a total knee replacement, which will cause greater trauma. I listened to experts from Beijing, Shanghai and Guangzhou talking about this matter at an industry seminar two days ago. It was quite lively with both sides holding different opinions. In fact, to put it bluntly, individualized treatment is needed. There is no one-size-fits-all solution. Our clinical practice now generally refers to the opinions of both sides. We will not tell patients which solution is absolutely better. We will explain the pros and cons and let the patients make their own choices.

Of course, not all patients can be solved conservatively. We have three tough measures. As long as two of them are met, surgical intervention will basically be recommended. First, the pain is so painful that even taking ordinary non-steroidal anti-inflammatory drugs is useless. For more than three months in a row, the pain is so painful that I can’t sleep at night. I have to take three breaks when I go out to buy groceries. My quality of life is completely unprotected. ； The second is to take an MRI to see if the cartilage is worn to III degree or above, or joints often lock - that is, when you are walking, your legs suddenly get stuck and you cannot move, and you have to shake twice before you can continue walking. ； Third, the alignment of the lower limbs has been significantly deformed. The O-shaped and

When it comes time to go to the operating table, many people think that everything will be fine if they find a good doctor, but this is not the case. Last year, I managed two patients who underwent arthroscopic cleaning on the same day. One was a 48-year-old young programmer who loves to exercise. Before the operation, we told him that he could use the ankle pump 6 hours after the operation, and he could walk on crutches the next day. He was very strong in execution. He did 200 ankle pumps a day and 15 sets of quadriceps contractions. He was off crutches and went to work normally two weeks after the operation. ； Another 70-year-old man in the same ward heard from his family that he had to "recuperate" after the surgery. He lay down for a whole week without moving. His legs were as swollen as steamed buns. He almost suffered from venous thrombosis in his lower limbs. He was discharged from the hospital after staying for three weeks. His recovery speed was not even a fraction of a second.

Interestingly, there is no unified standard for postoperative rehabilitation. Some rehabilitation practitioners advocate that the knee should not bend more than 90 degrees for a week after the operation to avoid pulling on the wound. Others advocate that "no pain is reasonable". As long as the degree of pain is within the tolerable range, you can bend as much as you can and open up the range of motion as soon as possible. Our current experience is that it depends on the patient. If the joint mobility is very good before the operation, there are no adhesions, and it does not need to be stuck. If it has been stiff for several years before the operation, don’t rush it. Take it step by step and take your time. Forcibly breaking the cartilage will damage the newly repaired cartilage.

Many people feel that they are done after the sutures are removed after surgery. They should climb stairs and carry heavy objects without controlling their weight. I met a 55-year-old patient two years ago. After a total knee replacement, he felt that the new joint was "invincible". He went to climb mountains and dance square dances every day, and gained 20 pounds by eating braised pork. It took only two years for the prosthesis to wear out and he came back for renovation. It is a pity. Some people go to the other extreme and dare not move after surgery. They sit and lie down at home every day. Their muscles have atrophied, which puts extra burden on their joints, and they start to hurt again within a few years.

To be honest, whether it is conservative care or surgery for arthritis, it is essentially "30% cure and 70% nourishment". Surgery is like replacing a new hinge on your broken door. If you slam the door every day, don't apply oil, and stuff sand into the cracks, no matter how good the hinge is, it won't last long. Don't be so scared that you need surgery as soon as you hear about arthritis, and don't go to the hospital until the pain is so severe that you can't walk. Finding a reliable doctor and choosing a plan that suits you is better than anything else.