Bone and Joint Department

The Department of Bone and Joint Surgery of Peking University People's Hospital was established in 1987. It is a department primarily dedicated to the treatment of various bone and joint diseases, with knee and hip joint replacement and arthroscopy as its specialties.

The department currently has more than 50 physicians, technicians, and nurses, including 9 chief physicians, 3 associate chief physicians, and 2 supervising technicians.

The Department of Bone and Joint Surgery is one of the earliest clinical centers in China to perform artificial joint replacement and arthroscopic surgery. In the early 1990s, the Department of Bone and Joint Surgery of People's Hospital developed rapidly, with comprehensive improvements in medical care, education, and research. It has now developed into a comprehensive department characterized by knee and hip joint replacement and arthroscopic surgery, with complete diagnostic and treatment equipment, well-established specialist groups, an increasing number of new technologies and therapies, and a growing number of scientific research projects. In 2000, this center was elevated to the Peking University Institute of Joint Diseases. The center provides staged treatment for patients with joint diseases at different stages, including exercise, minimally invasive surgery, and artificial joint replacement surgery. Some of its work has already reached an internationally advanced level. At present, the center performs more than 2,000 artificial joint replacement procedures and nearly 1,000 various arthroscopic procedures each year. The center’s project “Clinical Application and Related Basic Research of Artificial Knee Joint Replacement” was awarded the First Prize for Scientific and Technological Progress by the Ministry of Education in 2002 and the Second Prize for National Scientific and Technological Progress in 2007.

## Introduction to the Key Specialty of the Department of Bone and Joint Surgery

The Department of Bone and Joint Surgery of Peking University People’s Hospital was established in 1987 and is one of the earliest clinical centers in China to perform artificial joint replacement and minimally invasive arthroscopic treatment. In 1990, the Joint Disease Diagnosis, Treatment and Research Center of Peking University People’s Hospital was officially established. In 2000, this center was elevated to the Peking University Institute of Joint Diseases. As a national-level key discipline, the Department of Bone and Joint Surgery focuses on the surgical treatment of joint diseases such as advanced rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, femoral head necrosis, and developmental dysplasia of the hip. It has carried out extensive work in artificial joint replacement and arthroscopy, particularly knee replacement, and has reached an internationally advanced level in terms of the number and difficulty of replacement procedures and surgical outcomes. Related clinical and basic research on joint diseases has filled a number of gaps in China and abroad. Through diversified educational and training programs for graduate students, international students, and visiting physicians, the department has established joint disease diagnosis and treatment subcenters nationwide, as well as an application network for telemedicine education and consultation, thereby elevating the development of joint surgery in China to a new level. The project “Clinical Application and Related Basic Research of Artificial Knee Replacement Technology,” summarized and submitted by the Department of Bone and Joint Surgery, received the Second Prize for National Scientific and Technological Progress in 2007. “Artificial Joint Replacement for Severe Multiple-Joint Deformities in Patients with Rheumatic Joint Diseases” received the Second Prize for Beijing Scientific and Technological Progress.

The department has distinctive clinical diagnosis and treatment characteristics. Adhering to the principle of “patient-centered” care, it has earned an excellent reputation among a broad patient population through high-standard clinical diagnosis, treatment, and services. The department’s specialized diagnosis and treatment are mainly reflected in the following aspects:

1. Artificial Joint Replacement

The Department of Bone and Joint Surgery is one of the earliest clinical centers in China to perform artificial joint replacement. For advanced bone and joint diseases, it performs joint replacement surgery involving the knees, hips, ankles, elbows, shoulders, and the small joints of the feet and hands. For patients with severe rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, hemophilic arthritis, gouty arthritis, and other conditions, more than 10,000 knee replacement procedures have been completed to date. For patients with severe rheumatoid arthritis, femoral head necrosis, developmental dysplasia of the hip, fractures of the femoral neck in elderly patients, and other conditions, more than 7,000 hip replacement procedures have been completed to date. Artificial joint replacement treatment is performed for patients with severe deformities of multiple lower-limb joints caused by advanced rheumatic diseases. In accordance with China’s specific conditions, improvements and innovations have also been made in surgical methods, surgical sequencing, surgical scope, and perioperative management. These include: overcoming the contraindication to surgery associated with 60° flexion contracture of the knee; selection of the surgical sequence for patients with multiple lower-limb joint deformities caused by rheumatic diseases; simultaneous replacement of multiple joints in a single operation; perioperative management of patients with advanced severe rheumatic disease and high surgical risk; and taking the lead in performing artificial joint replacement for systemic lupus erythematosus hip arthritis, hemophilic arthritis, pigmented villonodular synovitis, neuropathic arthritis (Charcot’s arthritis), psoriatic arthritis, and ankylosed knees in the extended position. The Department of Bone and Joint Surgery has carried out extensive groundbreaking work, clinically restoring the ability to stand and walk for a large number of patients in China with advanced joint diseases and improving the standard of surgical treatment for joint diseases in China. While producing direct benefits, this work has also generated enormous social benefits. The vast majority of patients treated have regained confidence in life and returned to work. The above work has opened up a new treatment pathway for joint disease surgery in China, provided research data of extremely high academic value for related international fields, and offered a valuable reference for the surgical treatment of joint diseases in developing countries similar to China. It has received favorable recognition from peers both in China and abroad.

2. Artificial Joint Revision

Because of the complexity and variability of clinical conditions, artificial joint revision is a major challenge in the field of artificial joints. Each year, the Department of Bone and Joint Surgery admits numerous patients from all over China for revision surgery due to artificial joint failure caused by infection, aseptic loosening, periprosthetic fracture, liner or implant wear, and other causes. Over the years, the department has accumulated extensive experience in artificial joint revision surgery. It is at an advanced domestic level in the principles for managing infection after joint replacement, the treatment of bone defects during joint revision surgery, prosthesis selection, and other areas.

3. Minimally Invasive Arthroscopic Treatment

The Department of Bone and Joint Surgery is one of the earliest units in China to perform arthroscopic surgery and has more than 30 years of experience. In 1983, our department began performing knee arthroscopy examinations and arthroscopic surgery. In 1990, our department began performing arthroscopic anterior and posterior cruciate ligament reconstruction, as well as arthroscopic surgery of the shoulder, elbow, wrist, hip, ankle, and other joints. It has accumulated extensive experience in the diagnosis and minimally invasive treatment of injuries and diseases affecting all the major joints of the body. At present, the department’s minimally invasive treatment team, led by Professor Ni Lei, a nationally renowned specialist, performs more than 700 various arthroscopic procedures each year.

4. Rehabilitation After Artificial Joint Replacement

Good postoperative rehabilitation exercise therapy is the guarantee of favorable outcomes after artificial joint replacement. The Department of Bone and Joint Surgery cooperates with several secondary hospitals in Beijing to help train and establish professional teams and wards for rehabilitation after artificial joint replacement, ensuring that joint replacement patients achieve good rehabilitation exercise outcomes.

5. Postoperative Follow-up System and Outpatient Telephone Appointment Service

To ensure postoperative rehabilitation outcomes, designated staff members of the Department of Bone and Joint Surgery conduct telephone follow-up with patients at 6 weeks, 3 months, and 6 months after surgery, provide rehabilitation guidance, and remind patients to attend outpatient follow-up examinations on time. In addition, to facilitate outpatient visits, the Department of Bone and Joint Surgery has also established an outpatient telephone appointment service. Patients may call 010-88326259 (Monday to Friday, 8:30–11:00 a.m. and 2:00–4:30 p.m.) to make an appointment at the specialist outpatient clinic of the Department of Bone and Joint Surgery.

6. Specialized Nursing

The nursing team also adheres to the principle of “patient-centered” care and provides comprehensive, continuous, proactive, professional, and human-centered holistic nursing under a primary nursing system. Specialized nursing begins even before the patient is admitted, including assisting physicians in screening the preoperative physical condition of patients awaiting admission in the outpatient setting, providing education, arranging admission registration, and so forth. After admission, the team provides education on inpatient precautions and preoperative education. For patients undergoing joint replacement and arthroscopic surgery, various forms of perioperative treatment and functional exercise are implemented. Patients after discharge receive regular follow-up to assess their functional recovery, with timely guidance provided as needed.

7. Exercise and Rehabilitation Therapy for Osteoarthritis

Exercise is recommended as a cornerstone of osteoarthritis treatment by multiple authoritative international guidelines for the diagnosis and treatment of osteoarthritis, and numerous studies have confirmed its effectiveness in treating osteoarthritis. Several developed countries already have mature exercise therapy programs that are widely used in the treatment of osteoarthritis. However, insufficient attention is currently paid in China to the application of exercise in osteoarthritis treatment. This year, our department began providing exercise therapy for patients with arthritis in the outpatient setting, achieving an excellent response and good treatment outcomes. Professor Lin Jianhao has now established a specialized “Arthritis Exercise and Rehabilitation Clinic” on Wednesday afternoons.

The Department of Bone and Joint Surgery adheres to the principle of integrating scientific research with clinical practice and using scientific research to provide guidance and services for clinical practice. It has conducted related clinical and basic research, filling a number of gaps in China and abroad. In-depth research has been conducted on the pathogenesis and clinical treatment of joint diseases, including ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, and systemic lupus erythematosus. This research includes: establishing susceptibility genes and transgenic animal models for ankylosing spondylitis; studying the role of synovial cells in the pathogenesis of rheumatoid arthritis; conducting an epidemiological survey of knee osteoarthritis among elderly people in northern China; and, in the field of surgical treatment of advanced joint diseases, conducting related research on artificial joints, such as stress shielding after artificial femoral head replacement; research on domestically produced antibiotic bone cement; the effects of an irrigation gun on the bone–bone cement interface; measurement of the anatomical geometry of the normal Chinese knee joint, including the proximal femur and patella; research on the diagnosis, prevention, and treatment of deep vein thrombosis after artificial joint surgery; research on autologous blood retransfusion after artificial joint surgery; and large-scale prospective clinical follow-up research based on the principles of evidence-based medicine to determine the optimal timing of synovectomy for rheumatoid arthritis. The project “Clinical Application and Related Basic Research of Artificial Knee Replacement Technology,” summarized and submitted by the institute, received the Second Prize for National Scientific and Technological Progress in 2007. “Artificial Joint Replacement for Severe Multiple-Joint Deformities in Patients with Rheumatic Joint Diseases” received the Second Prize for Beijing Scientific and Technological Progress.

The department compiled and published *Artificial Joint Surgery* in 1998, the first monograph in this field in China. After revision and further improvement based on that book, *Modern Artificial Joint Surgery* was published in 2006.

With improvements in internal medicine diagnosis and treatment technologies for rheumatic diseases in China, as well as the intensification of population aging in China, the number of patients with advanced rheumatic joint diseases has gradually declined, while elderly patients with osteoarthritis have increasingly become the main population receiving treatment in joint surgery. Therefore, the department has gradually shifted the focus of its research to the basic and clinical research of osteoarthritis, including epidemiological investigation and research on osteoarthritis; the use of magnetic resonance imaging (MRI), biological markers, and other methods for the early diagnosis and assessment of osteoarthritis; and the application of articular cartilage regeneration and osteochondral transplantation in the treatment of osteoarthritis.