Arthritis Care Orthopedic Surgery

The vast majority of early- and mid-stage arthritis does not require orthopedic surgery. Only when the articular cartilage wear exceeds 70%, conservative treatment is completely ineffective for more than 6 months, and daily activities are severely limited, is the clear indication for orthopedic surgery. The weight of postoperative care is much higher than that of the surgery itself, which directly determines 80% of the final recovery effect.

I was particularly impressed by Aunt Zhang, whom I met at the outpatient clinic last week. She is 52 years old. Her knees have been hurting for three years. She has a hard time walking up and down stairs. The X-ray showed that the cartilage wear has only reached 2 degrees, not even half of it. She carried the report sheet and asked about joint replacement. She said that several old sisters in the community did not feel pain when dancing in the square after doing it. She insisted that I write a hospitalization bill for her. I persuaded her to go back, prescribed some topical analgesics, and made an appointment for strength training at the rehabilitation department. Yesterday she came for a review and said the pain was much less severe, and it was no problem to go to the vegetable market for half an hour.

Having said this, someone must ask, isn’t minimally invasive surgery now advertised as having less trauma and faster recovery? Wouldn’t it be better to do it early and get rid of the pain early? In fact, there have been two schools of thought in the industry: one school advocates early intervention, especially arthroscopic cleaning and microfracture surgery. The wound is only two keyholes in size, which can remove worn debris and proliferated synovial membrane, slow down the rate of cartilage wear, and is suitable for young patients with high exercise needs. ； The other group believes that as long as it is not to the point of being unable to walk, try not to do it. After all, whether it is minimally invasive or joint replacement, it is an invasive operation, and artificial joints generally have a service life of only 15 to 20 years. If you do it too young, you will most likely need a second revision when you get older. The difficulty and risk of revision surgery are much higher than the first time.

Personally, I prefer "individualized assessment". There is no absolute decision on whether to do it or not, just whether it is suitable or not. Two years ago, I met a 38-year-old mountaineer who had a torn meniscus and 3rd degree cartilage wear. According to the guidelines, he was completely in compliance with the indications for arthroscopic surgery. However, he said that he had to run half marathons with his children twice a year and go hiking on weekends. He could not accept being unable to move for half a year after the operation. In the end, we did not perform surgery on him. Instead, we adjusted his exercise mode, changing his hiking mode to swimming and elliptical machines, along with three months of sodium hyaluronate injections and quadriceps strength training. At the end of last year, he even sent me a half-marathon completion certificate, saying that his knees are now a little sore except after strenuous exercise, and they basically don’t hurt at all.

If it is really assessed that patients must undergo surgery, I will usually emphasize to them repeatedly in advance: Don’t put all your hopes in surgery. Surgery only helps you replace or repair broken joint parts. Whether it can be used smoothly depends on the subsequent care. The most regrettable patient I have ever seen was a 68-year-old patient who had a very good knee replacement surgery. During the operation, his range of flexion and extension could reach 130 degrees. However, after he returned home, he was afraid of pain and refused to move. He lay in bed every day to rest. When he came for a review in three months, his legs could only bend up to 90 degrees and he could not squat when going to the toilet. In the end, he had to undergo another joint release, which was a second sin.

Oh, by the way, many elderly people now have prejudices against taking painkillers after surgery. They think that "the medicine is only three parts poisonous" and they refuse to take it because of the pain. I always argue with them for a long time: You are sweating all over the body in pain, and you don't even dare to lift your legs. In the end, you have adhesions and need surgery. Wouldn't that make it even worse? As long as you take the painkillers according to the dosage, there is no big problem with short-term use of painkillers, and the benefits are much higher than taking them by force. Also, don’t listen to the talk of “you need to take a lot of supplements after surgery”. Drink big bone soup every day. The soup is full of fat. If you don’t supplement calcium, you will easily gain weight. For every pound of fat, the knee joints will bear an additional 3 pounds of pressure, which is not conducive to recovery. Normally eating high-protein foods such as eggs, milk, and lean meat is enough.

As for arthritis patients who are not yet indicated for surgery, the key point of care is actually one sentence: use sparingly, but don’t use it completely. Don't go climbing stairs and do square dances every day, and don't lie on the sofa every day. Muscle atrophy will be bad for your joints. Taking a walk, swimming, and riding a stationary bicycle are all good exercises. Pay attention to keeping your joints warm and don't catch cold. If the pain is severe, apply some topical analgesics. Don't carry it.

To put it bluntly, arthritis is essentially the "aging wear and tear" of joints. It is the same as the door shaft that has been used for a long time at home and becomes astringent. There is never a standard answer to whether or not to have surgery. If you usually like to go out for a walk or dance square dance with your old sisters, and the pain is so severe that you can’t even leave the house, then do what you need to do. Nowadays, the technology is very mature, and your quality of life will improve a lot after you recover after the operation. ； If you usually like to read books and plant flowers at home, and the pain does not affect your daily life, then conservative treatment is enough, and there is no need to undergo that surgery. You don’t need to follow what others say is good. What suits you is the best.