Concept of Rapid Rehabilitation The concept of rapid rehabilitation surgery refers to the application of a variety of proven methods to minimize surgical stress and complications and to accelerate the patient’s postoperative recovery during the preoperative, intraoperative, and postoperative periods. Components of Rapid Recovery Rapid recovery surgery generally includes the following important components: (1) Preoperative patient education. (2) Better anesthesia, pain management and surgical techniques to reduce surgical stress, pain and discomfort. (3) Intensive postoperative rehabilitation, including early mobilization out of bed. Rapid rehabilitation surgery must be a multidisciplinary process involving not only surgeons, anesthesiologists, rehabilitation therapists, nurses, but also the active participation of the patient and family. The following is a typical case of knee replacement and revision history to illustrate. 1, the patient’s general condition 36-year-old male patient. Complaint: left knee pain, deformity, activity limitation for 8 years. Past medical history: ten years history of gout. Specialized physical examination: left knee flexion contracture deformity. Knee mobility 30 degrees-90 degrees. Mack’s sign (±), grinding test (+), drawer test (-), lateral stress test (+). There was no localized skin erythema or warmth. HSS knee score: 29 Diagnosis: gouty arthritis Normal cardiopulmonary function No contraindications to surgery. Laboratory examination: blood and urine routine was normal, liver and kidney function was normal. crp: 25mg/L, ESR 30 mm/h, blood uric acid 461μmol/L. Preoperative X-rays and gross radiographs 3. Surgical approach As the patient’s knee joint stability was poor, and flexion contracture deformity, we prepared a surface knee replacement. We were prepared to perform surface knee replacement or condylar restrictive knee replacement, and the specific surgical method was further determined according to the specific situation during the operation. 4. Preoperative education Inform us of the surgical method, expected clinical results, and postoperative precautions. Detailed information on the key points of each stage of rehabilitation and the possible duration. Advise on various suggestions to promote recovery. Suggestions and measures to encourage early oral feeding and getting out of bed. Postoperatively, inform the patient of the operation and strengthen the patient’s confidence in rehabilitation and exercise. 5.Analgesia Preoperative: oral NSAIDs + buprenorphine transdermal patch Intraoperative: periarticular injection (ketamine + ropivacaine + saline) Postoperative: analgesic pump + static analgesic drugs (Tranexamic) + ice 6.Anesthesia(Priority according to the order of precedence) Femoral nerve block anesthesia + postoperative analgesic pump Epidural nerve block anesthesia + postoperative analgesic pump General anesthesia 7.Operative precautions Cooling down of the operating room: the room temperature drops the body temperature does not drop, the Heat preservation air cushion. Controlled hypotension: mean arterial blood pressure is reduced to 70% of the basal blood pressure Autologous blood transfusion: shorten the operation time to reduce bleeding: tranexamic acid 10min before the operation, 1.0g IV. Another 1.0g IV was given at the end of surgery. Intraoperative 3.0g with 100ml saline joint cavity immersion for 5min. 8, Postoperative treatment Prevention of infection: 1st generation cephalosporin 2.0g 30min preoperative + q.12.h postoperative * 24-48hr Prevention of thrombosis: anticoagulant therapy (apixaban) is started 24-48hr postoperatively Rehabilitation: Rehabilitation program is carried out at the bedside on the 1st day of the postoperative period, the volume of infusion is strictly controlled, and the patient is encouraged to eat and drink. 9.Rehabilitation Stage 1: Postoperative day 1-3. Ankle pumping exercise, elastic bandage with slight compression, ice pack cold compress, passive knee flexion over 90° and full extension (passive) Stage 2: Postoperative days 4-7. Active knee flexion reaches or exceeds 90 °, can be actively straightened, can adapt to sitting stool and standing status, and can walk on the ground with the help of a walker. Stage 3: Postoperative day 8-14. Knee flexion reaches or exceeds 120 °, can be actively straightened, can support the walker down to walk back and forth, increased stride length, speed, to avoid claudication. 4 weeks later, take off the crutches to move around. 10, one week postoperative X-ray film and body photo 11, 3 months postoperative X-ray film and body photo 12, 16 months after the periarticular infection 16 months after the operation, the patient’s knee joint pain, local wounds red and swollen, in the local hospital antibiotic treatment for two weeks. CRP, blood sedimentation mildly elevated, blood routine normal, joint fluid culture negative. He was readmitted to the hospital and underwent knee joint debridement, prosthesis removal and antibiotic bone cement filling. 13. Postoperative treatment Postoperative bacterial culture result: Pseudomonas aeruginosa Sensitive antibiotics: imipenem, cefoperazone/sulbactam Blood sedimentation, CRP, blood routine, calcitoninogen completely returned to normal after 2 weeks of sensitive antibiotic treatment. Then continue to use sensitive antibiotic treatment for 2 weeks and then stop the drug. Observe continuously for 3 months without using any drugs, and recheck the blood sedimentation, CRP, blood routine and calcitonin every month, which are completely normalized, then the revision surgery can be performed. 14. Observe continuously for 3 months without using any drugs, and review the blood sedimentation, CRP, blood routine and calcitonin every month, and they are completely normal. He was re-admitted to the hospital to take out the antibiotic bone cement filler and fill the bone defect with metal bone trabecular cone to do the knee revision surgery. 15. One week after the operation, the patient started to walk and exercise on the ground by taking X-ray film and gross photographs.