Postoperative rehabilitation is a very important factor affecting the outcome of total hip and total knee replacement surgery. For a long time, many doctors only pay attention to the surgical operation itself and neglect post-operative rehabilitation; and many patients often like to put the good or bad surgical results on the doctors and neglect the importance of their own exercise. The problems in this category are mainly reflected in the following aspects: 1. Most doctors tend to be conservative in the issue of postoperative rehabilitation. This conservatism has some historical reasons and is also partly due to the current complex doctor-patient relationship. Because of this conservatism, doctors do not recommend early rehabilitation exercises and do not encourage patients to walk on the ground early, and some doctors do worry that patients will have problems after exercising too early. I believe that these concerns are unnecessary unless one feels that there is a problem with the surgery itself. Cemented arthroplasties provide immediate stability, and even with a non-cemented total hip replacement on both sides, there is no problem walking immediately after the surgery. With the artificial joint surgery I had, I had to try to get out of bed and stand and walk after the drainage tube and catheter were removed, even taking into account the pain factor, no later than the third postoperative day. During those days in the hospital bed, I also asked the patient to do active joint flexion and extension and muscle contraction exercises. The patient must be discharged from the hospital with the knee fully extended and in flexion over 90 degrees. Once a doctor tends to be conservative, his or her post-operative functional recovery will be greatly compromised if he or she does a good job. A good joint surgeon must be confident in surgical operation and post-operative rehabilitation. 2. Many patients tend to be more conservative under the influence of their doctors. Without the encouragement of the surgeon, patients tend to be cautious in their post-operative rehabilitation, fearing that excessive exercise will in turn affect the outcome of the surgery. Some patients spread their pre-surgery fears to the post-surgery period, using post-surgery pain and discomfort as excuses for not wanting to exercise actively. Taking total knee arthroplasty as an example, I have seen many patients in the clinic who prefer to rely on CPM (Continuous Passive Motion) machines, that is, they are very willing to do passive exercise and not very willing to exercise actively on their own. Regarding the role of CPM, studies have actually shown that it has no significant effect on post-operative rehabilitation of the joint. Active rehabilitation is the fundamental motivation for later functional recovery. This is not a good way to put the cart before the horse. Of course, the main reason why patients are not motivated is because they do not receive good post-operative rehabilitation education from their health care providers. Most patients listen to their doctors. If the doctor is too conservative, it is very difficult for the patient to be active. 3. In the field of rehabilitation medicine, our philosophy and facilities are generally backward. In foreign countries, rehabilitation medicine is given far more attention and development than in China. I was impressed by this during my study at the University of Hong Kong Medical School. The orthopedic joint replacement ward at Queen Mary Hospital is equipped with a special physiotherapist to provide professional rehabilitation guidance to each post-arthroplasty patient during his or her stay. After discharge, patients are usually transferred to the MacLehose Rehabilitation Home for further formal rehabilitation training of various kinds. I had a close tour of this largest and most well-equipped medical rehabilitation center in Hong Kong, and was deeply impressed by how far behind China is in this specialized field. In fact, it is not that we do not have the conditions to establish such a rehabilitation center, but we have long lacked the concept of post-operative rehabilitation and the high importance of rehabilitation training for patients. At present, our prosthetic joint patients receive only very limited and informal rehabilitation guidance after surgery. After discharge from the hospital, patients actually need further rehabilitation instruction, yet we have almost a void in this area. I once saw a patient on the ward who had had a total knee replacement on one side three months ago and was admitted for a total knee surgery on the other side. I asked her how she was recovering from her last surgery, but was shocked by the answer I received because the patient told me she had been in bed since her last surgery and had not gotten off the floor to walk. When I asked why she didn’t get down and walk around, she said the doctor had not instructed her to do so. Although this can be a rather extreme example, it is a reflection of the dilemma we have in post-operative rehabilitation. Although I myself pay more attention to this area than other doctors, I sometimes feel that there is more to it than meets the eye, because I am not a professional in rehabilitation medicine after all, and it is difficult for me to devote much time and energy to it. To address the root of this problem, a dedicated rehabilitation medicine team is needed. Until this becomes a reality, we can only hope that both doctors and patients will work together and actively participate in the post-operative rehabilitation of artificial joints.