Total hip arthroplasty is the most effective of the joint reconstruction surgeries and is accompanied by planned functional exercises to maximize joint function, correct deformity and relieve pain. Total hip arthroplasty is one of the more mature modern surgical procedures. The replacement of the painful part of the damaged hip with a designed artificial joint component is called hip replacement, and this joint substitute is called a prosthesis. According to the latest statistics, 95% of artificial prostheses are used for more than 10 years and 90% for more than 20 years. The purpose of artificial hip arthroplasty is to relieve pain, correct deformity and restore joint function. Pre-operative psychological care is common in the elderly, most of them are usually physically fit, but due to sudden accidents, the lower limbs become impaired and cannot take care of themselves, resulting in anxiety, depression and fear. Depression after hip fracture is an obstacle to fracture recovery. According to the different psychological characteristics, experience, cultural quality, living habits and professional hobbies of patients, we adopt different ways of conversation, patiently explain to patients the relevant medical knowledge and treatment technology rehabilitation care and advanced equipment, and ask patients with good efficacy and fast recovery after the operation to introduce their personal experience, understand the process and effect of the operation, relieve their psychological pressure and worries, actively cooperate with the treatment, and establish confidence to overcome the disease and pain. Prognosis Prognosis and rehabilitation care The surgery is usually performed under epidural anesthesia. If the patient complains of chest tightness and panic, with increased pulse rate, pale face and cold sweat, even if the blood pressure is normal, attention should be paid to whether there are signs of early shock. At the same time, actively open peripheral veins and prepare oxygen inhalation and emergency drugs. Skin traction should be performed for 1 to 2 weeks after the patient returns to the ward, with a weight of 3 kg, which may easily cause dislocation. In addition to paying attention to the direction, angle and weight of traction, special attention should be paid to the activity and sensation of the affected limb. If the dorsal extension of toe muscle strength is reduced or the skin of the dorsal foot and lateral calf is numb, it should be treated in a timely and comprehensive manner. Therefore, after the patient returns to the ward, the nurse should confirm the site of the drainage tube, fix it properly, prevent it from falling off, bending and blocking, and squeeze it regularly to ensure its smoothness. If the drainage volume is small, the hip joint is full or swollen, corresponding care measures should be taken in time, such as adjusting the position of the affected limb, replacing the negative pressure drainage device, etc. Functional exercise: (a) Early: 2-7 days after surgery, keep the affected limb in a neutral position of 15-30 degrees of abduction and wear “Ding” shoes to prevent hip dislocation. 1, muscle isometric contraction exercises, the so-called isometric contraction is the active contraction of the muscle but does not cause joint movement. The isometric contraction of the quadriceps muscle is practiced on the second day after surgery. Method: The nurse stands on the affected side of the patient and places the right hand on the N fossa of the affected limb and the left hand on the knee joint with the palms facing each other. The patient was asked to straighten the knee joint, and the affected limb was relaxed after pressing down on the nurse’s right hand, while the nurse’s left hand was clearly felt to twitch up and down the patella once. With this repeated downward pressure and relaxation action, the quadriceps muscle can get a better isometric contraction. Generally, after instructing the patient 2~3 times, he/she can master the action well and then perform active exercises. Repeat 20 times/group, gradually increasing to 40 times/group, 2~3 groups per day. 2, toe flexion and dorsiflexion exercise: the main is to maximize the flexion and extension of the affected limb small joints, and drive the calf muscle movement. Avoid internal and external rotation of the hip joint. Hold each movement for 10 seconds, repeat 20 times/group, 2~3 groups per day. 3.Hip contraction exercise: patient lying down, contract the hip muscle for 10 seconds, relax; hands on the force, do the hip lifting action, hold for 10 seconds, repeat 20 times / group, 2~3 groups per day. 4.Straight leg raising exercise (active mainly, passive supplemented): raise ≤30°, hold time 10 seconds and gradually increase to 20 seconds. Simultaneously perform deep breathing exercises. The frequency and intensity of the exercises are generally 5-10 minutes for every interval of 1~2 hours, to the extent that you do not feel very tired. On the third day after surgery, you can sit up and perform light hip flexion exercises under the guidance of the doctor, but the time should not be too long, generally limited to half an hour. Starting functional exercise as early as possible is the fundamental measure to prevent deep vein thrombosis. Mid-term: 8 – 15 days after surgery, continue to carry out early functional exercise. 1.Supine hip flexion and knee flexion exercise: hold the knee with one hand and the heel with the other hand, flex the hip ≤90° without causing abnormal pain, and prohibit the hip joint from internal contraction and internal rotation, otherwise it will lead to hip joint dislocation. 2.Reclining to sitting exercise: support the bed with both hands, flex the healthy leg to extend the affected leg, and use the support force of both hands and the healthy leg to hang the affected leg naturally under the bed, 2~3 times a day. 3, sit to stand point training: patients first sit up in bed, no dizziness and other symptoms, sit down at the edge of the bed, first under the healthy limb and then under the affected limb, hands should hold the edge of the bed, and gradually get out of bed. After no dizziness and palpitations and other symptoms, then start to stand on the edge of the bed holding the crutches for 10 seconds/group, 2~3 times a day. 4.Walking practice by standing on the edge of the bed with the help of crutches: walking should hold the crutches without weight walking, someone next to protect. Each time 20 seconds, 2~3 times a day. 6 – 8 weeks after surgery can be partially weight-bearing. The healthy leg steps first, the affected leg follows, and the crutches follow. The step of crutches is the focus of education (the correct posture of crutches: the height of crutches should be adjusted according to the height of the patient, the general height is the patient to hold the crutches with both hands, the top of the crutches is 5-250px from the armpit, the same width as the shoulder. Because the force of crutches in the hands rather than the armpits to support the body, otherwise it is easy to cause brachial plexus nerve palsy, once it occurs, although rest can be recovered, but will affect the patient’s mood and the process of functional exercise. The correct way to walk: after standing well first out of the left abduction, step right foot, out of the right abduction, step left foot. The correct posture for going up and down stairs: When going up stairs, the healthy limb goes up first. (When going down the stairs, the affected limb goes down first.) (iii) Late stage: 3 weeks – 3 months after surgery, patients in this period are usually discharged home, continue to carry out the medium-term functional exercise, and gradually increase the time and frequency of exercise. Six don’ts” within 6 weeks after surgery: don’t cross your legs; don’t lie on the affected side (if you lie on the affected side, put a soft pillow between your legs); don’t stilt your legs; don’t lean forward when sitting; don’t bend over to pick up things; don’t sit with your knees bent in bed. The time to abandon the crutches varies from person to person, but generally after the walking is stable and there is no walking pain. After full recovery, appropriate physical activities can be carried out, such as walking, dancing, bicycling, etc. Heavy physical labor and strenuous exercise should be avoided. Defecation should not be done in squatting position. The purpose of the follow-up visit is to guide the patient for further rehabilitation and to protect the use of the artificial joint in order to achieve the best results of the surgery.