Post-operative Rehabilitation Program for Artificial Total Ankle Arthroplasty

  1. On the day of surgery: 1. The special position of the affected limb should be maintained: supine position with pillows between the knees, knees and toes upward to prevent internal rotation of the hip, and semi-sitting position as early as possible; 2. The patient is instructed to start active contraction of the quadriceps, triceps and tibialis anterior muscles to accelerate venous reflux and prevent deep vein thrombosis.  3. Give cold packs for 24 hours to relieve pain, keep the airway open, and encourage the patient to breathe deeply and cough to prevent lung infection.  The first day after surgery: 1. Remove the plasma drainage tube and urinary catheter in the morning, and instruct the patient to get out of bed and walk with a walker.  2.Ankle dorsiflexion: active maximum flexion and extension of the ankle joint and resistance training, hold each movement for 5 seconds, repeat 20 times/group, 2 to 3 groups per day.  3.Quadriceps training: do static contraction of quadriceps, hold for 5 seconds each time, 20 times/group, 2-3 groups/day; 4.Patients do straight leg raising exercise in bed, not requiring the height of lifting, but about 5 seconds of stagnation time; 5.Slowly flex the knee and hip to slide the heel of the affected limb toward the hip, keeping the toe upward to prevent internal rotation of the hip.  6.Resistance muscle strength training: resistance adductor and resistance abductor and other long muscle strength training can be performed, each action is held for 5 seconds, repeat 20 times/group, 2 to 3 groups/day.  The patient should be more active and strengthen the dorsiflexion, plantarflexion and quadriceps training of the ankle joint.  Postoperative days 4-14: Focus on muscle strength exercise and increase joint activities, and discharge the hip joint with 70° to 90° of flexion, 15° of abduction and 10° of external rotation. Teach the patient to walk with a double crutch and arrange a post-discharge rehabilitation training program. During this period, supine straight leg raising and knee and hip flexion training should also be performed. And strengthen the postural transfer training and joint mobility training.  Fifth, the second to third week after surgery: In addition to the above training, strengthen hip flexion, abduction and external rotation exercises, and the training method must be correct to prevent joint dislocation. Train the patient to walk with a single crutch.  Sixth, the fourth week to three months after surgery: should carry out functional training of daily life, teaching patients how to go to the toilet, put on and take off shoes and socks, sit in the car, go up and down the stairs, patients who did not do the large rotor osteotomy should abandon the crutches walking in about 6 weeks. At the same time, the patient should be asked to review regularly to prepare for the patient to return to society.  7, precautions: 1, sitting: the first month after surgery, sitting time should not be too long, so as not to cause hip edema, can also use cold compresses and elevate the affected limb to improve, keep the knee joint lower than or equal to the hip, should not sit too low chairs, sofas, do not cross legs and ankles, do not bend forward more than 90 degrees, sit with the body backward leg forward.  2.Toilet: use a raised homemade toilet seat to go to the toilet, or lean back and extend the affected leg forward to go to the toilet with the assistance of the body, pay attention to keep the knee joint higher than the hip.  3.Fetching things: Don’t bend down to pick up things on the ground within 2 weeks after surgery, don’t suddenly turn around or reach for the objects behind you, and it is advisable to put the rice bowl in front of you when eating.  4.Ride: sit with your hips positioned forward, lean your body backward and stretch your legs forward as much as possible.  5.Shower: After the wound has healed, the auxiliary hold can reliably take a shower, because there is a certain danger of standing in the shower, so you can sit on a high stool, the nozzle is a removable hand-held nozzle, and prepare a bath sponge with a long handle so that it can reach the lower limbs and feet.  6.Put on and take off shoes and socks: ask someone to help you or use shoe plugs, choose elastic shoes without laces, loose pants, and carry shoes medially for those with lateral incisions after the line and laterally for those with medial incisions before the line.  7.Physical activities that can be performed after full recovery: walking, gardening, cycling, bowling, table tennis, swimming, dancing, and maintaining proper weight. Avoid activities that produce excessive pressure on the new hip joint causing wear and tear, such as jumping, fast running, skiing, water skiing, tennis, etc.