2. Pay attention to the posture of walking and working, and don't twist your body to walk and work. Avoid squatting for a long time, because the weight of the knee joint when squatting is 3 ~ 6 times its own weight. At work, it's best to squat (such as car mechanic and sand Turner) and sit in a low position (sitting on a small bench), sit and stand for a long time, and often change posture to prevent the knee joint from fixing a posture and exerting too much force.
Don't wear high heels when walking for a long distance. Wear thick-soled and elastic soft-soled shoes to reduce the impact on the knee joint and avoid the wear of the knee joint.
4. When taking part in physical exercise, be prepared for exercise, gently stretch the knee joint, and then take part in strenuous exercise after the knee joint is fully active. When practicing leg press, don't suddenly lift your legs too high to prevent your knees from overstretching. When practicing Tai Ji Chuan, don't squat too low, and don't play several sets in succession to prevent knee joint overload injury.
5. When riding a bicycle, you need to adjust the height of the seat. It is advisable to sit on the saddle. There are two pedals on the pedal, and the legs can be straight or slightly bent. Too high or too low when riding uphill or pedaling hard will have adverse effects on the knee joint.
6. When the knee joint is cold, the blood vessels contract and the blood circulation deteriorates, which often aggravates the pain. Therefore, when the weather is cold, we should pay attention to keep warm and wear knee pads when necessary to prevent the knee joint from catching cold.
7. People with knee osteoarthritis should go up and down stairs as little as possible, climb less, stand less for a long time, and lift less heavy objects to avoid aggravating the condition due to excessive knee joint load.
8. People with knee osteoarthritis should not only avoid excessive fatigue of the knee joint, but also carry out proper functional exercise to increase the stability of the knee joint and prevent leg muscle atrophy, which can not only relieve joint pain, but also prevent the disease from progressing. Don't think that only rest and inactivity can protect the sick knee joint. According to research, swimming and walking are the best exercises for people with knee arthritis, which not only increases the bearing capacity of the knee joint, but also exercises the muscles and ligaments around the knee joint. Secondly, sit-ups, push-ups, bridge arches, repeated practice of lifting and retreating on the supine bed, and imitation of pedaling bicycles are all the best exercises for patients.
9. In terms of diet, you should eat more foods containing protein, calcium, collagen and isoflavones, such as milk, dairy products, soybeans, bean products, eggs, fish and shrimp, kelp, black fungus, chicken feet, pig feet, leg of lamb and beef tendon. These can not only supplement protein and calcium, prevent osteoporosis, but also lubricate cartilage and joint growth, and supplement estrogen. Traditional Chinese medicine's explanation of the etiology and pathogenesis of arthritis was first found in Neijing. Su Wen's Bi Lun pointed out that "wind, cold and dampness are mixed to be arthralgia, and the wind prevails to be arthralgia, and the cold prevails to be arthralgia, and the so-called arthralgia is also due to cold and dampness". In addition, Bi Lun also believed that "the so-called diet is the root of its disease", and the occurrence of arthralgia was related to diet and living environment. In Su Wen's comment on fever, he said: "Wind and rain are cold and hot, so it can't be weak, and it can't harm people alone." "Because it doesn't fit with wind, cold and humidity, it is not arthralgia." It can be seen that the ancients not only saw its external factors, but also realized its internal factors. Generally speaking, wind, cold, dampness and heat are the external conditions for the occurrence and development of arthritis, while insufficient internal memory and vital qi are the internal reasons for its onset.
According to the theory of arthritis treatment in traditional Chinese medicine, "wind-cold-dampness evil blocks meridians, making them impassable, thus causing pain". Therefore, Chinese medicine can achieve good clinical therapeutic effect by treating wind-cold, relieving spasm and dredging collaterals, promoting blood circulation and removing blood stasis.
Evaluation of knee replacement
From 65438 to 0977, NIH started a mechanism system-evaluating popular new medical technologies. This assessment may have an impact on health policy (for example, whether a certain treatment is covered by insurance, etc.). ). This mechanism was soon followed by many western countries. So far, NIH has published about 75 such assessment reports. The latest evaluation is about total knee replacement (TKR), which was published in the 6th issue of JBJS in 2004. The conclusion of the report is summarized as follows (please read the original text if you are interested). (1) is mainly used for bones;
(2) Other indications include juvenile arthritis and other types of joint inflammation. (1) remission period;
(2) Improve the function.
Patients who intend to receive TKR should have
(1) Radiological evidence of joint injury;
(2) Persistent moderate to severe pain, which has not been relieved after a period of non-surgical treatment;
(3) The clinical joint function is definitely limited, which affects the quality of life.
Age of TKR patients
(1) In the past, it was considered that 60-75 years old was the most suitable for TKR；; .
(2) Older patients often have more other systems; Young patients will increase the mechanical failure of prosthesis because of their strong mobility;
(3) Patients under 55 years old should consider other treatment methods such as osteotomy and single condyle replacement.
TKR absolute contraindication
(1) local or systematic;
(2) Complications associated with other diseases increase the risk of perioperative complications or death.
Relative contraindications:
(1) Obesity: Actually, it is not a contraindication, but it will increase the risk of delayed wound healing and perioperative infection.
(2) Severe peripheral vascular diseases and some neurological disorders. (1) The perioperative mortality rate was 0.5%;
(2) TKR can quickly and effectively relieve pain, improve function and improve patients' quality of life in 90% patients, no matter in short-term or long-term; 85% patients are satisfied with the surgical results.
(3) The reason why the surgical effect is not obvious is not clear. (1) wound healing problem
(2) superficial or deep infection
(3) deep vein embolism and
(5) myocardial infarction
(6) Patella fracture and/or knee extension device
(7) joint instability, stiffness and/or force line is not straight.
(8) Nerve and blood vessel injuries.
Factors of complications
(1) Incision and deep infection factors: arthritis, obesity and glucocorticoid use.
An important factor for the success of TKR is surgical technique. Some studies show that the number of surgical cases between surgeons and patients is inversely proportional to the incidence of complications.
Prosthesis failure problem
(1) Incidence: 10 years 10%, 20% in 20 years, equivalent to an annual increase of 1%.
(2) Causes of early failure of prosthesis: The patient is younger than 55 years old, suffering from diseases such as human, osteoarthritis and obesity. (1) annual operation volume of doctors
(2) Surgical technique.
(3) Selection of prosthesis (1) Whether the line of force of prosthesis placement is correct is very important;
(2) The design of rotating platform and preserving posterior cruciate ligament has theoretical advantages, but it does not show advantages in TKR for the success of operation and the survival time of prosthesis.
It is helpful to improve the management in operation.
(1) systemic prophylactic use of antibiotics
(2) Active postoperative analgesia.
(3) Perioperative health assessment of patients and treatment of related diseases.
(4) patient education
Perioperative management is not clear.
(1) Preventive use of anticoagulants to prevent pulmonary embolism;
(2) All kinds of perioperative rehabilitation training;
(3) autologous blood transfusion, blood transfusion, etc.
Witness of transforming TKR
(1) Patella fracture or dislocation
(2) the prosthesis is unstable or aseptically loose
(3) Infection
(4) Periprosthetic fracture
(5) Postoperative pain without cause 5)TKR (whether it is listed as an indication is controversial)
Corrected contraindications of TKR
(1) Persistent infection
(2) The quadriceps femoris or knee extension device is limited in height.
(3) poor skin coverage
(4) Poor blood supply
(5) Poor bone quality
Modified TKR prediction
(1) is not as good as the first TKR.
(2) Aseptic loosening is better than infection.
Repair the failed rescue.
(1) resection and arthroplasty
(2) Joint fusion
(3) amputation