The knee joint is the largest and most complex joint in the human body and plays a vital role in daily life for walking, going up and down stairs, and standing in a sitting position. If the joint surface of the knee joint is worn, defective or damaged for various reasons, resulting in joint space narrowing, walking pain and functional impairment, it will seriously affect the quality of life. Artificial knee arthroplasty is one of the most effective and reliable means of treating advanced knee osteoarthritis. It is reported that 90% of patients at home and abroad can get satisfactory results after artificial knee arthroplasty. However, for an elderly patient, an artificial knee replacement is not a non-invasive or minimally invasive procedure such as the installation of dentures or an IOL, and requires a higher level of systemic condition and more post-operative precautions. The decision to have a knee replacement must be made after an evaluation of the patient’s health and condition, and after consultation between the patient and family members and the orthopedic surgeon at the hospital. Adequate preoperative preparation, including psychological, family and physical preparation, is a prerequisite for a good outcome of the artificial knee replacement. Psychological preparation It has been reported that in the United States, with a population of nearly 300 million, there are approximately 600,000 knee replacement surgeries each year, with the percentage of knee replacement surgeries performed on people over 60 years of age exceeding 40%, who use knee replacement surgery as a routine treatment for knee osteoarthritis to improve their quality of life. In China, the acceptance of knee replacement surgery has increased significantly in recent years, but is still generally lower than in developed Western countries. Geriatric patients often refuse knee replacement surgery because they do not know enough about it, or they have the opposite attitude and have high postoperative expectations of knee replacement surgery. Therefore, it is essential that the patient be properly prepared and adjusted before surgery. First, elderly patients should psychologically eliminate their fear of artificial knee replacement. Our clinical practice over the past 30 years has shown that the vast majority of patients can significantly reduce knee pain after surgery, significantly improve their function, take care of their daily activities, and improve their quality of life. Secondly, the difference between the artificial knee joint and the natural joint needs to be viewed correctly. The artificial knee is not comparable to the natural joint of a normal person, and most patients cannot make the joint do extreme flexion greater than 130 degrees as they did when they were young, and for this reason, there are still problems such as difficulty in fully squatting. Also, patients are not expected to perform strenuous aerobic exercises including running or galloping, contact sports, jumping exercises, etc. after surgery. Furthermore, the artificial knee joint has a certain lifespan. Over 90% of patients are able to use it for 15-20 years, and some foreign reports show that new wear-resistant prostheses can even last 25-30 years, but older people should still take care of their joints as much as possible and not overuse them while enjoying the benefits of an artificial knee. We recommend that patients do the following before undergoing knee replacement surgery: 1. Ask yourself if you are ready for knee replacement surgery, and approach the surgery with a relaxed mindset. 2. Tell your surgeon your expectations for the outcome of the surgery. 3. Talk to your surgeon about the procedure, how to stay in the hospital, the type of anesthesia, how to choose a prosthesis, the number of days you will stay in the hospital, recovery, and pain management. 4.Arrange your work and life properly and wait for the surgery without worries. 5. Quit smoking and drinking, practice deep breathing, quadriceps stretching, ankle pump exercise; practice holding the crutches; practice bed urination and defecation. Family preparation Pre-operative family preparation and psychological preparation complement each other. Family preparation includes how to reasonably choose the prosthesis, preparation for the cost of surgery, personnel care and home activities arrangements. The selection of artificial joint prosthesis should take into account the patient’s expectation of the period of use of the artificial joint, the expectation of the function of the artificial joint and the family’s financial ability. Age is a key factor in determining the duration of use of an artificial joint. Since the average artificial knee joint has a life expectancy of 15-20 years, older patients over the age of 70 can choose an inexpensive and affordable general prosthesis. However, for patients younger than 60 years of age, a slightly more expensive prosthesis with better wear resistance (e.g., rotating platform weight-bearing surface prosthesis, ceramicized weight-bearing surface prosthesis) may theoretically last longer. The expectation of improved postoperative function is also an important factor in the selection of an artificial knee. Excellent postoperative function should be based not only on good joint stability, but also on a good range of motion of the joint. With the same surgical technique and rehabilitation conditions, the postoperative knee mobility of the patient is mainly related to the preoperative range of motion. In short, patients with preoperative joint stiffness will end up with less postoperative joint mobility, and patients with good preoperative joint mobility will have relatively better postoperative mobility. Therefore, for patients who are likely to achieve a greater range of motion, it is reasonable to use a safe, wear-resistant high-flexion artificial knee joint (slightly more expensive), while for patients with pre-existing stiffness, a common prosthesis is sufficient. We recommend that patients and their families communicate fully with the surgeon and decide on the prosthesis together. At present, the price of various imported prostheses in China varies, with ordinary prostheses costing around 30,000, and some wear-resistant prostheses or high-flexion prostheses costing around 40,000-50,000, with some reimbursement depending on the proportion of medical insurance for the artificial joint. Patients still need to be taken care of for cooking, shopping, bathing and laundry for 3 months after surgery. Even if the patient is able to walk normally, it is recommended that he or she should do functional walking exercises under the supervision of a family member. Although it is said that the arrangement of home activities are some details, they are crucial to the postoperative rehabilitation and the long-term success or failure of the surgery. According to some experiences summarized at home and abroad, we suggest preparing the following aspects: 1. a toilet seat or a toilet stand with a high seat. 2.A walking aid or a pair of crutches. 3.A stable bathing chair or stool. 4.Put daily necessities such as telephone, TV remote control, common medications, etc. in a more accessible place. 5, in the shower or bath place, to firmly installed handrails or safety chair. 6, do not place loose carpets and wires at home. 7. A firm chair with a height that keeps both knees below the hips in the seated position, with a hard back and two armrests. Physical Preparation Once the patient has decided to undergo the artificial knee replacement surgery, the patient should undergo immediate preoperative physical preparation. This is when the patient undergoes a thorough physical examination to rule out any medical conditions that may affect the surgery and its outcome. These preparations and examinations include the following: 1. Routine examinations: routine blood tests, coagulation tests, electrocardiograms, x-rays, lower extremity force line x-rays, etc. Patients with rheumatoid arthritis should routinely have their C-reactive protein and blood sedimentation checked; elderly patients over 65 years of age should have their cardiopulmonary function routinely checked. The above examination can be done in orthopedic outpatient clinic or after hospitalization. 2.Tell the doctor if there are any systemic medical diseases, allergies to various drugs, and snoring in sleep, so that relative treatment can be done during the surgery. 3.People with diabetes should control their blood sugar below 10mmol/L and make effective control of blood sugar for a long time after the operation. 4.Keep the skin clean and free of infection. Because skin infections even minor carbuncles and boils can easily cause postoperative joint staphylococcal infections. Special attention needs to be paid to the treatment of tinea pedis. 5.Pay attention to urinary tract infection, especially for women, they should develop good personal hygiene habits and do more water and cleaning regularly. 6.Dental diseases such as periodontal disease and gingivitis can allow dental bacteria to enter the blood stream and lead to joint infection. Therefore, 3 weeks before the artificial knee replacement, dental diseases should be properly treated first (including tooth extraction and periodontal treatment). Routine dental cleaning is recommended to be stopped within 2 weeks before and after the artificial knee arthroplasty. 7. Strengthen muscle exercises around the knee joint before surgery. Even if the joint has obvious pain and deformity, patients should be encouraged to walk under the protection of anti-inflammatory and pain-relieving medications and walkers. Those who really cannot walk need to do knee extension and leg raising exercises in bed. 8. Control hypertension, practice deep breathing, enhance nutrition, and quit smoking and alcohol. Proper preoperative preparation is the prerequisite and guarantee to ensure satisfactory surgical results. We believe that with the joint efforts of patients, families and joint surgeons, you will be able to get back your confident and wonderful life!