Artificial knee replacement has been proven to be an effective treatment for various end-stage knee diseases, and good function after TKA comes largely from timely and correct rehabilitation functional exercises, therefore, functional exercises should be performed as early as possible after surgery under the guidance of doctors to overcome fears and inertia.
1.The methods and data provided in this plan are formulated in accordance with the general routine, and the specific implementation should be completed under the guidance of doctors depending on their own conditions and the surgery.
2.A certain degree of pain is unavoidable during the functional exercises. If the pain can subside to the original level within half an hour after the exercise stops, it will not cause damage to the tissue and should be tolerated.
3, muscle strength exercises should be concentrated until the muscle has a sense of soreness and fatigue, and then proceed to the next group after sufficient rest. The number of exercises, time, load depending on their own situation, and should be practiced at the same time the healthy side. Good muscle strength is a key factor in joint stability and a guarantee of good knee function and must be practiced carefully.
4.In addition to the proper braking protection of the operated limb, the rest of the body parts (such as the upper limb, waist and abdomen, and the healthy side of the leg) should be practiced as much as possible to ensure physical quality, improve the overall level of circulation and metabolism, and promote the recovery of the operated local.
5.Joint mobility (flexion and extension) exercises strive to improve the angle each time. If the flexion angle does not progress for a long time (>2 weeks), there is a possibility of joint adhesions, so great importance should be attached to it and insist on completing the exercises.
6.Ice packs are usually given for 15-20 minutes immediately after the mobility exercises. If you usually feel swelling, pain and fever in the joint, you can apply ice again, 2-3 times a day.
7.The side with shadow is the affected side.
8.The swelling of the joint will accompany the whole exercise process, and it is normal that the swelling does not increase with the angle exercise and activity, until the angle and muscle strength basically return to normal swelling will gradually subside. Sudden increase of swelling should adjust the exercise and reduce the amount of activity, and in case of seriousness, timely follow-up should be made.
Early stage
On the day of surgery.
1.After surgery, the affected limb should be placed in the straight position and pillow should be placed under the calf and heel to elevate the affected limb to prevent swelling.
2. After the anesthesia subsides, start to move the toes and ankle joint, and if possible, start ankle flexion and extension activities (ankle pump exercises).
Ankle pump exercise – forceful, slow, full range of flexion and extension of the ankle joint to promote blood and lymphatic return through the squeezing effect of calf muscle contraction and diastole. 5 minutes/group, 1 group/hour.
This exercise is important to prevent swelling and deep vein thrombosis and promote blood circulation in the affected limb, so it should be practiced carefully.
3. Start “external counterpulsation” treatment according to the situation to further promote the blood circulation of the affected limb.
1 day after surgery: 1.
1.Ankle pump exercises for 10-15 minutes/group, 1 group/hour.
2. Isometric contraction exercises for the quadriceps and N cord muscles. (should be done as much as possible without increasing pain)
Quadriceps isometric exercises – i.e. thigh muscle tensing and relaxation. >300 reps/day.
N cord isometric exercises – the affected leg is pressed down hard on the pillow, so that the posterior thigh muscles are tensed and relaxed. The requirements are the same as above.
3 stretching exercises: padding at the heel, light load on the knee joint, 30 minutes/time, >2 times/day.
2 days after surgery.
Continue and strengthen the above exercises.
3 days after surgery.
Removal of drainage (according to drainage)
1. Straight leg elevation exercises: straight leg elevation after knee extension until heel is 15M from bed, maintain until exhaustion.
2 Maintain sitting position frequently and do not lie down for a long time to avoid the occurrence of postural hypotension.
3. Stand on the ground under protection, put weight on the affected leg within the range of slight pain, and walk short distances under the protection of a walker (only for activities necessary for life such as going to the toilet). Do not walk for too long. Hold off the exercise if the patient is obviously weak.
Postoperative day 4.
1.Strengthen stretching exercises
2.Weight-bearing and balancing exercises (standing position weight shift exercises)
Weight-bearing and balancing – separate both feet under protection and move the center of gravity alternately from side to side within the range of slight pain. 5 minutes/time, 3 times/day; separate both feet anteriorly and posteriorly and move the center of gravity. 5 minutes/time, 3 times/day.
5. Walk on the ground with the help of a walker.
5 days after surgery.
1.Continue and strengthen the above exercises.
2.Walking exercises (using a walker, with the help of protection), and gradually extend the walking distance.
3.Practice using crutches
4.Position transfer exercises: such as getting in and out of bed, chair sitting exercises, etc.
1 week after surgery.
1.Strengthen weight-bearing and standing exercises
2.Passive exercises can be carried out by the rehabilitation doctor according to the situation if the flexion angle is obviously limited. Or under the guidance of sitting leg hanging: sitting on the edge of the bed, below the knee hanging outside the bed. Relax the thigh muscles under protection and allow the lower leg to drop naturally to the limit for 10 minutes. If necessary, add load to the ankle joint. 1-2 times/day, aiming for daily progress in flexion angle. If necessary, the rehabilitation doctor will help you to complete the exercises.
3. Active knee flexion and extension exercises: sitting position, foot does not leave the bed. Slowly and forcefully flex the knee to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day.
Mid-term
2 weeks postoperatively.
1. patellar release (performed after stitch removal): push and hold the edge of the patella by hand and push the patella slowly and forcefully in the up and down and left and right directions to the limit position. 20 times in each direction, 2-3 times/day. You can practice by yourself after being taught by a rehabilitation doctor.
2.Try to put full weight on the affected leg.
3.Passive flexion >100 degrees.
4.Active flexion up to 90 degrees.
Heel lift exercise: Under protection, stand with feet about 10 cm apart and distribute the supporting weight equally between both legs. Lift the heel (i.e. heel off the ground and stand on the toes.) To the limit, hold for 10 seconds, 30 times/group, 2-4 groups/day, 30 seconds rest between groups.
3 weeks after surgery: (Increase the knee flexion angle by about 10° per week. (If the pain is not obvious, increase the range of motion as soon as possible.)
1. thigh adduction and abduction exercises: start side leg raising exercises. 30 times/group, 2-4 groups/day with 30 seconds rest between groups.
2. Bedside anti-gravity knee extension exercises: sit on the edge of the bed with the knee joint hanging naturally below the bed, forcefully and slowly extend the knee until it is as straight as possible, hold for 10 seconds and slowly lower it in a controlled manner. 10-20 times/group, 2-3 groups/day.
4 weeks post-op.
1. 0-30 internal flexion/extension exercises in standing position.
Under protection, stand with feet apart, shoulder-width apart, supporting weight equally distributed between the legs. Flex both knees simultaneously to approximately 30 degrees, then slowly extend.
30 times / group, 2-4 groups / day.
2, prone position “leg hook exercise”, should be static exercises, bend the knee to a pain-free angle to maintain 10-15 seconds. 30 times / group, 4 groups / day.
Use sandbag as the load, within the pain-free range of motion, and apply ice immediately after the exercise. If the healthy side of the leg is painless, you can choose the standing position “hook leg” exercise.
3.Static squatting exercise. Back against the wall, feet shoulder-width apart, toes and knees are forward, not
”inside and outside the eight”, with increasing strength gradually increase the angle of the squat (less than 90 °), 2 minutes / time, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day.
4, VMO exercises (the last 15 degrees of knee extension anti-gravity exercises).
Sitting position, a rigid pillow under the affected knee, so that the knee joint is in a position of 15 degrees of flexion, slowly and forcefully straighten the knee joint and hold it in the straightest possible position for 5 seconds, 30 reps/group, 2-4 groups/day, 30 seconds rest between groups.
5. stationary bicycle exercises, no load to light load. 30 min/set, 2 sets/day.
Postoperative period
2 months after surgery.
1.Intensive muscle strength and joint mobility exercises.
2.Start the knee exercises of semi-squatting flexion and extension of the affected leg in 45° position on one side. Stand with the affected leg on one leg, straighten the upper body, slowly squat down to 45° of flexion
and then slowly pedal until completely straight. 20-30 reps/group, interval between groups
30 seconds between sets, 2-4 times/day.
3. ADL exercises (going up and down stairs, etc.).
STEP10cm-15cm: that is, choose 10cm high steps as shown for forward and lateral stepping up and down exercises. Note that when completing the movement, use the affected leg to support the weight, and slowly exert force to experience the muscle sensation and control the stability of the joint. 30 times/group, 2-4 groups/day, with 30 seconds rest between groups.
3 months after surgery.
Resume full activity as determined by review.
Remarks.
I. Methods of exercises for flexion.
Choose any one of the following methods. Once a day, aim for a slight increase in angle is sufficient. If there is any special discomfort during or after the exercise, promptly inform the doctor. Exercise process shall not be straightened rest, repeated flexion and extension, otherwise it will affect the effect, and very easy to cause swelling.
1.Sitting (or supine) position hanging leg.
Sitting on the edge of the bed lying down, below the knee hanging outside the bed. Relax the thigh muscles under protection, so that the calf drops naturally, to the limit of protection for 10 minutes. If necessary, add load at the ankle joint.
2.Supine leg hanging:.
Supine on the bed, thighs perpendicular to the bed, under the protection of the relaxed thigh muscles, so that the calf drops naturally, the requirements of the same as above.
3, sitting position “top wall”:.
Sitting chair, the affected side of the toe top wall or fixed, slowly move the body forward to increase the bending knee angle, feel the pain and keep still, a few minutes after the pain disappears or lower, and then move forward to the limit. The whole process is controlled within 30 minutes.
4.Active flexion and extension exercises: (performed after passive flexion)
Sitting position, the foot does not leave the bed. Slowly and forcefully, flex the knee to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day.
II. Exercises for extension and flexion.
Stretching exercises in the muscles and rear joints of the pulling sensation and slight pain is normal, do not contract the muscles against, should be completely relaxed, otherwise it will affect the effect. The weight of the load used in the exercise should not be too large, should make the affected knee dare to relax, and last up to 30 minutes, there is a clear sense of pulling is appropriate. No breaks should be taken in the middle of the exercise, otherwise the effect will be affected.
1. Seated knee extension.
Sitting position, foot cushioned and weighted above the knee joint. Relax the muscles completely and hold for 30 minutes. 30 minutes / time, 1-2 times / day.
2. Prone suspension.
Prone, hanging below the knee outside the bed, weighted at the ankle joint. Requirements as above.
3.Active stretching.
Hold at the limit for 10 seconds, relax for 5 seconds. 20-30 times/group, 1-2 groups.