Surgery Godfather-Chapter 698 - 623: Hand it Over to Us

Having left the ward, Yang Ping washed his hands back in his office.

Everyone sat down to discuss the treatment plan.

In fact, there are certain methods for patients with metal allergies undergoing joint replacement.

If simplified, the problem is easy: in severe metal allergies, conservative treatment is chosen.

For bilateral knee osteoarthritis at this severe stage, conservative treatment is equivalent to giving up treatment, which goes against Yang Ping’s commitment to giving his all.

Before seeing the patient, he would scan through the medical records; after seeing the patient, he would review the records again. This is a routine in consultation.

By reviewing old knowledge, new understandings can be gained. Occasionally, reviewing records can lead to unexpected discoveries.

In the past, Yang Ping was a junior doctor, now as a senior doctor, he needs to give his juniors the chance to think.

Though he could exercise with countless cases in the system space, Song Zimo and Xu Zhiliang only had the real cases for practice, so Yang Ping refrained from voicing his thoughts prematurely.

"Metal allergy, the non-allergic reactions are more severe."

Yang Ping reviewed the medical records while saying with slightly narrowed eyes.

Director Chang, standing to one side with one hand resting on the back of Yang Ping’s chair, said, "Exactly. Since his family told us about his history of metal allergies, we were cautious and tested him for all the metals involved in prosthetics. The reactions were all strongly positive. We’ve never seen a patient who is allergic to all these metals."

Patients with metal allergies are already rare, let alone those allergic to several metals simultaneously.

Director Chang meant to imply: It isn’t our incompetence, but rather the patient’s complicated condition. Anyone would be helpless.

To reinforce his point, Director Chang continued, "We also considered using gold joint prosthetics, but given this strong allergic reaction, we worried too."

A golden joint, is not actually made of gold but refers to the specific process used in making the prosthesis, where a physical vapour (TiNbN) is deposited onto a cobalt-chrome-molybdenum substrate, followed by high-precision polishing.

TiNbN can effectively reduce the release of cobalt-chrome-molybdenum metal ions, has better bio-compatibility, and can prevent metal allergies, providing a more reliable solution for patients with metal allergies. Its bonding strength, durability, wear-resistance, bio-compatibility, fatigue-resistance, and safety all surpass those of ordinary artificial knee joints.

Because the surface of the prosthesis is golden in color, it’s colloquially known as ’golden joint’ by doctors.

This type of prosthesis could be used in patients with metal allergies, but for patients with such serious allergic reactions, they dare not use it since once the surgery is completed, there is no turning back.

Although TiNbN can reduce the release of cobalt-chrome-molybdenum metal ions, it cannot completely stop the release of metal ions.

As long as the metal ions can be released, there’s a possibility of an allergic reaction.

If an allergy-caused loosening of the prosthesis and severe inflammatory reaction in the surrounding soft tissues occurs, leading to a non-healing surgical incision, it would result in disastrous consequences.

Holding off one more surgery doesn’t matter much to Director Chang, but if a disastrous operation is performed, Director Chang would probably have trouble sleeping and eating.

So, the ’golden joint’ is ruled out mercilessly!

As the chief surgeon of the Joint Surgery Department, Director Chang is also experienced. He has probably thought of every possible method.

"If there were a fully ceramic knee prosthesis, it would be nice," Xu Zhiliang said regretfully.

Ceramic artificial joints are most commonly used in hip replacements. Whether it’s ceramic on ceramic, or ceramic on highly cross-linked polyethylene, the low friction factor usually means ceramic prosthetics are considered high-end.

But the use of ceramic prosthetics in knee replacements is very rare. To say nothing of the knee, even in hips, it’s hard to get a ceramic prosthesis because the stem of the prosthesis is still metal.

The ceramics are usually alumina or zirconia, or a combination. Alumina has been used in artificial joints for over forty years, and zirconia for over thirty. Ceramics are hard, smooth, wear-resistant, and cause low attrition, making them good materials for artificial joints.

However, the downside is their brittleness; in case of damage, they easily shatter, although the likelihood of implanted ceramics shattering is now extremely low.

The best medical implant ceramics on today’s market are made by Germany’s CeramTec, almost all artificial joint manufacturers, whether from the United States, the United Kingdom or China, all purchase their ceramic blanks for artificial joint manufacturing.

No other country can produce qualified ceramics of this kind.

CeramTec’s medical implants hold a whopping 95% of the global market, an unequivocal monopoly.

"There are definitely no fully ceramic knee joint prosthetics on the market right now, even those that use ceramic on highly cross-linked polyethylene. The tibial end is still a metal brace," Song Zimo responded to Xu Zhiliang’s regret.

Due to the different modes of motion between the knee and hip joints, ceramics are more commonly used in the hips than the knees.

The hip joint is a ball-and-socket joint, where the head of the femur rotates within the acetabulum. freёwebnoѵel.com

However, the knee joint is a complex, primarily flexing joint, its movement involving flexing, rotating, and minute inward and outward shifts. These minute shifts can lead to the joint surfaces colliding, which ceramics cannot withstand, as it goes right to their weak point - their brittleness. Even slight damage from these collisions can cause the ceramics to crack.

Though the use of implanted ceramics is improving, no fully ceramic knee joints are available on the market yet.

"We’ve considered ceramics, but there are no fully ceramic knee joints available on the market. Any other ideas?" Director Chang asked nonchalantly, implying he’s considered everything and there are no loopholes.

Professor Yang, you must find a solution within this framework. Every way to consider it, Director Chang has already done so. Director Han has been quite satisfied with the Trauma Orthopedics and Sports Medicine departments recently but less so with the Spinal and Joint departments.

Director Chang was a bit discontent. After all, he performed surgeries every day, and Director Chang wasn’t lacking in competency. He wondered what else could be brought to the table.

Yang Ping had kept silent throughout, allowing others to express their opinions freely.

If a non-metal bone joint is needed, Germany is the place to look. The Germans are sitting right next to him. A few phone calls from them and the ceramic joint could be brought in.

But even if it is available, it can’t be used. This would involve certain medical regulations, not to mention that there are no mature products currently available.

This approach will not work. Yang Ping looked at the X-ray over and over again, contemplating.

"Professor, I’m familiar with CeramTec and Linger. I can inquire if they have such products," August said, understanding Yang Ping’s line of thinking.

Robert remained silent. He knew that even the major joint manufacturers in the United States used ceramic blanks from CeramTec. It’s impossible to have surpassed CeramTec’s research and development speed.

Whether it’s Director Chang or the orthopedic doctors, they couldn’t help but admire this. Having a foreigner offer to call and inquire about CeramTec products seems very impressive.

"Go ahead and ask!" agreed Yang Ping.

There’s no harm in asking, and it’s a chance to update themselves on the latest developments in ceramic artificial joints.

Professor Zhang has a famous saying: "If you can’t buy a plane ticket, figure out another way to get to Beijing". Now Yang Ping is trying to figure out his own way to go to Beijing. He certainly can’t walk there, can he?

"How about we take over this patient? We can take our time to find a solution," he suggested.

Yang Ping was not trying to lure patients away from the orthopedics department. This was not an issue.

If the patient were transferred to the Comprehensive Surgery Department, it would be much easier to deal with many things, like communicating with the family, discussing treatment plans. Consulting from another department only offers advice in the end.

Director Chang liked the idea. The patient could have been discharged after a consultation. It was merely the family’s insistence on trying their best. At Sanbo Hospital, the highest ceiling was the Comprehensive Surgery Department.

If the Comprehensive Surgery Department can’t fix it, then it is not Director Chang’s incompetence.

"Alright. When do we transfer?" Director Chang asked readily.

Yang Ping replied decisively, "We’ll transfer right now! I’ll go and communicate with the family."

The patient’s daughter had been lurking outside the doctors’ office several times, waiting for their response. If all else fails, they could get a discharge tomorrow.

Song Zimo went to call the patient’s children, while Xu Zhiliang made some arrangements with the chairs in the meeting room.

In the meeting room, Yang Ping met the patient’s daughter and two sons.

The daughter was the patient’s eldest child and naturally acted as the representative. It seemed that the lady did not mind being the representative.

"Who are these two gentlemen?" The lady seemed uneasy to see the two foreigners sitting nearby.

Yang Ping explained to her, "They are two visiting doctors in our department. Don’t mind them, they are here to learn from me."

The woman glanced at the two foreigners before she finally sat down with ease.

"What do you think of this arrangement? Today we transfer to our Comprehensive Surgery Department. We will need to conduct additional tests. Both knee and ankle joints will need to undergo an MRI. I need to understand the condition of the cartilage in the patient’s larger joints. After these tests, I’ll have a clearer picture of whether we can solve your problem or not. If we can’t, we’ll discharge from our department. If there’s a solution, I’ll discuss it with you in detail."

"Based on the current examination reports, I’m not sure if we can help the patient."

Yang Ping supplemented the details.

The patient’s daughter readily agreed and hesitated, "Of course, we are not in a hurry today. The purpose of coming to the hospital is to help my father solve the joint pain problem. If it can be solved, it’s better. If not, there is no way. Professor Yang, I know about your reputation. You have recently developed a very magical device for treating spinal curvature, haven’t you?"

Did the general public know about this spinal external fixator?

Yang Ping nodded affirmatively.

The patient’s daughter said, "There’s a child in our class with scoliosis who has been trying to schedule a surgery with you for a long time, but hasn’t managed to do so yet. They are saying they’ll have to wait for the third batch."

"What’s your last name, teacher?" Yang Ping asked with a smile.

The woman, who was about forty years old, said, "My surname is Wu. I teach at the Affiliated High School of the Normal University."

"Nice to meet you, Teacher Wu. Let’s proceed with the arrangement then. We will immediately arrange for a specialist. Whether or not a plan can be proposed depends on the results of tomorrow’s examination," Yang Ping said, seeing that they had no objections.

Teacher Wu was very easy-going, "You are the experts, we will cooperate fully. Professor Yang, you also don’t need to worry about the cost, we three siblings will share it equally, we are willing to pay any amount. My father has worked hard for us his entire life. Now that we have settled down, it’s time to repay him."

The patient’s two sons on the side kept nodding their heads, echoing their sister’s opinion. It seemed that when they were young, they had often been disciplined by their sister.

After the meeting was over, Song Zimo started making calls to have the on-duty doctors in the ward receive the patient.

Meanwhile, he and Xu Zhiliang were thinking about what plan Yang Ping might come up with. Since he had proposed a department transfer, he must have had some level of confidence.