Cai Daozhang, president of the Third Hospital of Southern Medicine, is inspecting the room.
Cai Daozhang, president of the Third Hospital of Southern Medical College, is undergoing joint surgery. Courtesy of the correspondent
According to statistics, nearly 1 million people in China have to replace artificial joints through surgery every year, and replace the damaged knee joints and hip joints of the human body to help people walk and exercise normally. Artificial joint replacement is a mature technology that has been carried out for nearly thirty years, but with the aging of the first artificial joints, and the replacement surgery itself has a certain early failure rate, the renovation of artificial joints has now become a professional subdivision of orthopedic surgery.
Not long ago, the Guangdong Artificial Joint Renovation Center was officially established in the Third Affiliated Hospital of Southern Medical University. The Third Hospital of Southern Medicine is also the Guangdong Provincial Orthopaedic Hospital, which is the first artificial joint renovation center in South China, and will convene experts to discuss the formulation of relevant diagnosis and treatment norms in Guangdong Province, and conduct standardized training for relevant doctors in the province.
Septuagenarians undergo three renovations after replacing their hip joints
What is "artificial joint repair"? Aunt Mo's case is more typical.
Aunt Mo is a 77-year-old wuchuan native of Zhanjiang, in 2014 due to femoral head necrosis in the local hospital "right side artificial total hip replacement", in 2015, 1 year after the operation found that the acetabular side prosthesis was loose, so she went to a hospital in Guangzhou for artificial joint revision, after the operation, she felt that the right lower limb was shortened, and two years later, the hip joint pain discomfort appeared again, in October 2017, the joint pain appeared again in 1 year after the operation, three revisions in April 2019, and the hip prosthesis dislocated two months after the operation. Aunt Mo went to the Joint Surgery Department of the Third Hospital of Southern Medical College for treatment.
Cai Daozhang, president of the Third Hospital of Southern Medicine, listened to Aunt Mo's self-reported medical history, his heart ached, the elderly in their 70s experienced several surgeries in many hospitals, the pain was not solved, but more and more serious, causing huge physical and psychological trauma to the patient, he arranged for Aunt Mo to be admitted to the hospital immediately.
After several renovations, Aunt Mo's joint problems are relatively complex and the technical difficulty is high, President Cai Daozhang performed a renovation operation for Aunt Mo, and guided the rehabilitation engineer to formulate a rehabilitation plan for Aunt Mo, and the patient was discharged after two weeks.
Now, two and a half years later, the 77-year-old can walk freely and his quality of life has greatly improved.
One in five patients requires revision surgery
According to reports, artificial joint revision surgery is a representative diagnosis and treatment technology for difficult and complex diseases in the field of orthopedics, and it is a re-operation for patients who have problems after artificial joint replacement surgery.
At present, nearly 1 million patients in the country need artificial joint replacement surgery every year, of which artificial joint revision surgery accounts for about 20%, and it is increasing year by year.
Zhao Chang, deputy chief physician of the Joint Surgery Department of the Third Hospital of Southern Medicine, introduced that artificial joints have a service life, 80%-90% of artificial joints can be used for 20 to 25 years, which is a relatively smooth situation, but China has been carrying out artificial joint replacement surgery for 20 or 30 years, and now the earliest batch of patients who replace artificial joints have the need for renovation.
There are also a small number of artificial joints that can experience "early failure," in which problems occur within three months of replacement. Why is there a problem? It is often due to infection, dislocation, or fracture that may require early revision.
For patients, what kind of symptoms mean that their artificial joints need to be "repaired"? In simple terms, the joints are not easy to use, they are not forced, they cannot walk, they are inconvenient to move, they are in pain, and so on.
Artificial joint renovation is difficult and costly
Artificial joint revision surgery, simply put, is "new for old", the old artificial joints that are not easy to use are taken out, and then installed with new ones, the principle is not complicated, but the operation is complicated and difficult.
For doctors, this kind of repair surgery is demanding, perioperative management is difficult, the probability of serious complications is high, the failure rate of surgery is high, and the disability rate after failure is high.
Renovation surgery is difficult, broken artificial joints are often accompanied by the wear and tear of bones, which brings difficulties to the secondary installation, Zhao Chang made an analogy, "If it is a normal piece of land, we repair a ten-story house only with a two-story foundation, but if it is a muddy rotten ground, it may take 5 floors down to repair it, we install artificial joints also need the patient's original bones as the 'foundation', and the wear and tear of the bones varies greatly, and it is necessary to stabilize the foundation with various special designs. Fix it".
In addition, sometimes it is also a problem to take out the original artificial joint, especially when the original joint is not completely loose but can no longer be used, it takes a lot of time and a lot of methods to take it out.
Other challenges include the control of infection around the prosthesis, the management of severe bone defects, and how to achieve good initial and long-term stability of the overhauled prosthesis.
For patients, this kind of renovation surgery is expensive. Zhao Chang introduced that because the revision surgery is more demanding than the first joint replacement surgery, the reinstalled artificial joints have higher requirements for material technology and high cost, and the domestic joints that are generally collected cannot meet the requirements, and imported joints need to be used, and the material cost alone will need 80,000 to 100,000 yuan, and the cost of the whole set of surgery may require 100,000 yuan.
Standardized training will be carried out for relevant doctors in the province
At present, there is no clear access system for artificial joint revision surgery, and each hospital can carry out it on its own, but because its requirements for surgical techniques are much higher than that of the initial replacement, the success rate of artificial joint revision surgery reported by various hospitals is different.
Therefore, under the guidance of the Guangdong Provincial Health Commission, the Third Hospital of Southern Medical College established the Guangdong Artificial Joint Renovation Center to undertake the quality control, talent training and technical support for the artificial joint renovation in Guangdong Province.
According to Cai Daozhang, president of the Third Hospital of Southern Medical College, the artificial joint renovation center will carry out work from different directions and different levels in the next five years. First of all, experts in artificial joint revision in the province were convened to discuss the formulation of diagnostic and treatment norms in Guangdong Province, establish an artificial joint renovation access system, and standardize training for doctors engaged in artificial joint reconstruction in Guangdong Province through various forms.
Secondly, build a consultation platform for difficult cases, and organize experts to give technical support and guidance for difficult repair cases. Third, jointly establish a large platform with superior resources in the province, and explore the reasons for the failure of artificial joints with big data, so as to reduce the renovation of artificial joints, carry out multi-center clinical research, explore clinical problems related to artificial joint renovation, and so on. Fourth, quality control of artificial joint revision surgery in the province. Fifth, develop new surgical instruments and new materials with independent intellectual property rights to reduce costs.
remind
Don't bear the discomfort of changing joints, and early renovation is simpler
Zhao Chang said that in view of the difficulty of revision surgery, the high price, patients also have to undergo the test of surgery and rehabilitation, Zhao Chang reminded the population who have carried out artificial joint replacement, to pay attention to postoperative rehabilitation, exercise the surrounding muscles, so that the joint function can be completely restored, while avoiding wrestling, clinically quite a lot of renovation needs are caused by falls, but also actively prevent infection, especially many elderly people have diabetes, once the body resistance declines around the joints are also prone to infection.
Zhao Chang will encounter some elderly people in the clinic to check the time is too late, the joints have been worn more seriously, "artificial joint wear will produce some debris, these debris will aggravate the bone loss around the joint, but also bring us difficulties in reinstalling the joint prosthesis, but also increase the cost of surgery."
He reminded people who have changed joints, if they find joint discomfort, do not blindly endure, to see a doctor early, if it is early loosening or wear, you can replace part of the joint to solve, "do not insist until you can not walk or the pain is obvious before coming to the doctor, then may be more serious wear, even if you have been changing the joint for one or two decades, what discomfort should be early to go to the hospital to see."
Written by: Nandu reporter Li Wen Correspondent You Hualing