Total artificial knee arthroplasty (TKA) is an operation with very definite efficacy, but if the success of the operation is only pinned on the surgical technique without postoperative rehabilitation, the operation will not achieve the proper efficacy. Through clinical practice, we have developed a post-operative rehabilitation program for artificial total knee arthroplasty. The purpose is to restore the patient’s limb function and self-care ability through early rehabilitation training. The main methods are preoperative guidance and postoperative training.
1.Pre-operative training
First of all, we should strengthen the static contraction exercises of the quadriceps muscle of the affected limb and the active movement of the ankle joint, requiring the quadriceps muscle to be contracted for 10 seconds each time, and every 10 times is one group, and 5 to 10 groups are completed every day.
The patient should sit on the bed and perform straight leg raising exercises and ankle joint resistance flexion and extension exercises, the number of times can be determined according to the patient’s condition and repeated 2 to 3 times a day.
In addition, patients should be taught how to use crutches to prepare for walking with a cane after surgery.
2. Postoperative rehabilitation training
The 1st week after surgery.
The purpose of this period is to reduce the patient’s symptoms, promote wound healing, prevent muscle atrophy, improve joint range of motion, and increase muscle strength.
(1) On the day of surgery, maintain the functional position of the joint, fix the knee joint with a plaster brace, and keep the foot high and hip low position.
(2) On the second to seventh postoperative days, the affected limb was subjected to static contraction of the quadriceps muscle, holding it for 10 seconds each time, with 10 sets of 10 times each day.
(3) The patient sits on the bed and does straight leg raising exercise on the affected limb without raising it too high, but with a lag time of about 10 seconds.
(4) Do dorsiflexion and flexion exercises and encirclement exercises of the affected ankle joint, repeat 15 times, complete 2 to 3 sets per day.
(5) Apply continuous passivemotion (CPM) machine to the affected limb in a painless state, with a starting angle of 0° and an ending angle of 40°, for 1 to 2 hours a day, reaching or approaching 90° within 1 week.
(6) 3 days after the operation, the patient can stand on the ground and try to walk a few steps, and then increase the time and number of times on the ground every day.
Postoperative week 2.
Focus on strengthening the active movement of the affected limb in the non-weight-bearing state and improving the active range of motion of the joint.
(1) Continue the activity program of the first week
(2) CPM activity of 90 degrees or more
(3) Active flexion and extension exercises of the knee joint, see later.
(4) Further strengthen the straight-leg raising exercise of the affected limb by fixing a pulley above the bed, holding the affected ankle joint with a sling at one end and the other end controlled by the patient, and completing the straight-leg raising exercise through assisted movement.
(5) Increase the time of off-bed activities, use a walker to link standing and walking, and perform gait training under the guidance of the doctor.
(6) Stitches are removed 10-15 days after surgery, and you can be discharged home to continue functional exercises.
Post 3rd week.
(1) Continue active straight leg raising exercise to consolidate the previous training effect, restore the weight-bearing capacity of the affected limb, strengthen walking gait training, train the patient’s balance and further improve the range of motion of the joint.
(2) Squatting exercises with the help of handrails.
(3) Walking training can be performed on a treadmill, with the patient looking forward with the head up and the chest out, and the hips not cocked.
(4) Pedaling can be performed on a stationary bicycle with the cushion starting from the highest.
(5) Patients should try to complete daily life actions such as putting on pants and socks independently during this week.
Postoperative week 4 to 3 months.
Focus on further strengthening and improving the results of the 3rd week, increasing the range of motion and weight-bearing capacity of the affected limb, as well as the ability to take care of oneself.
(1) Walking independently on a mildly inclined slope.
(2) Independently put on shoes, socks, pants and other activities of daily living.
(3) In addition to functional training for bending the knee, attention should also be paid to functional training for knee extension, such as leg press in sitting position.
(4) To go up and down stairs, early on, mainly rely on crutches to go up and down, with the healthy leg supporting and the affected limb bearing weight below to partially bearing weight, requiring the healthy leg to go up first and the affected leg to go down first, and then remove the crutches after the patient gets used to it.
(5) Regular exercise to restore knee mobility and gradually resume daily activities is very important for your full recovery after surgery. Early in your recovery, your doctor should recommend that you exercise 2 to 3 times a day for 20 to 30 minutes each time and walk 2 to 3 times a day for 20 to 30 minutes each time. You are recommended to perform the following functional exercises.
3.Early postoperative exercise
If your physical condition allows, start the following functional exercises as soon as possible. You can perform these exercises in the monitoring room soon after surgery. At first, you may feel discomfort, but these exercises will accelerate your recovery and reduce postoperative pain.
Quadriceps stretching exercises Tense your thigh muscles and straighten your knee as much as possible for 5 to 10 seconds. 10 times in 2 minutes, rest for 1 minute and repeat until your thighs feel tired.
Straight leg raise exercise Lie on your back with your knee fully extended, tense your thigh muscles, raise the affected limb 15 cm, hold it for 5-10 seconds and slowly lower it. Repeat the action only until the thigh feels fatigued.
You can also perform the sitting leg raise exercise, tense the thigh muscles and fully straighten the knee joint without any support. Repeat the movement. Perform these exercises periodically until thigh muscle strength is fully restored.
Ankle chirp Rhythmically move the ankle up and down more rhythmically, contracting the gastrocnemius and anterior tibial muscles. 2 to 3 minute sets, 2 to 3 sets per hour. Continue until full recovery and swelling of the ankle and lower leg is completely gone.
Knee Extension Exercise Roll up a towel and place it behind the ankle so that the heel is off the bed, tense the thigh and try to straighten the knee to the maximum extent so that the back of the knee touches the bed. Hold for 5 to 10 seconds and repeat until your thighs feel fatigued.
Recumbent supported knee flexion exercise Maximal flexion of the knee joint with the foot sliding on the bed. Maintain the maximum flexion position for 5 to 10 seconds then straighten. Repeat until the lower extremity is fatigued or until the knee can be fully flexed.
Seated Support Flexion Exercise Sitting on the edge of the bed and chair, place the foot of the normal side behind the ankle of the affected side for support and slowly flex and flex the knee joint. Hold in this position for 5 to 10 seconds. Repeat several times until the lower extremity is fatigued or until the knee can be fully flexed.
Seated unsupported knee flexion Sit on the edge of a bed and chair and flex the knee as fast as possible until the sole of the foot touches the floor. Shift your upper body weight forward to increase knee flexion and hold for 5 to 10 seconds. Fully straighten the knee joint. Repeat several times until the lower extremity becomes fatigued or you are able to fully flex the knee joint.
4. Early activity
Shortly after surgery, you will be able to walk short distances in the ward and perform daily activities. Early activity helps with recovery and restores strength and mobility to the knee joint.
Proper walking is the best way to help you recover and can be started with a walker or crutches. Distribute the total body mass on the walker or crutches in a balanced manner, stand upright and relaxed. Move the walker or crutches forward a short distance, starting with the surgical side leg, knee straight and heel first. This way, as you move forward, your knee and ankle will flex first, and then your entire foot will be smoothly planted on the floor. When you finish this step, lift your toes off the floor, flex your knees and hips, and move your body forward to begin the next step.
Be sure to remember the rhythm, landing heel first, flattening your foot, lifting your toes and walking as rhythmically and smoothly as possible, without rushing. Adjust the stride length and speed to achieve a steady gait As muscle strength and endurance return, gradually increase the walking time and gradually increase the weight of the burden on the affected limb. You can use the crutches with the opposite hand and eventually walk completely off the cane. When you can walk and stand for more than 10 minutes, the knee joint is strong enough to support your weight and you no longer need a walker. You can use a single crutch or cane with the hand on the opposite side of the surgery.
Do not limp or tilt your body to the side of surgery. Going down stairs – Going up and down stairs requires strength and flexion. You will need to grab the handrail at first and go up one step at a time. Go up the steps with the good leg first and down the steps with the surgical side leg first. Remember: “Up with the good, down with the bad. Have a chaperone help you a little while you practice until you regain strength and endurance.
Climbing stairs is a good physical and endurance exercise. Do not climb more than 20 centimeters in height and hold onto the handrail for balance. When you are satisfied with your strength and knee mobility, you can climb the stairs by yourself step by step.
5. Later exercises and activities
When you are able to walk independently for a certain distance and wait for a few steps, you can increase the amount of activity. The pain of the joint before surgery and the painful edema after surgery make the knee joint weaker. Full recovery may take several months. The following functional exercises and activities will help you recover completely.
Standing knee flexion exercises Stand upright with the help of a walker or brace and lift your thigh to maximize knee flexion for 5 to 10 seconds. Straighten the knee again, heel first, and repeat several times.
Assisted knee flexion exercises Lie on your back and fold a towel in half several times around the front of the ankle. Flex the knee joint and, pulling the towel tightly and slowly, increase the degree of flexion. Hold for 5 to 10 seconds. Repeat until you feel fatigue.
Knee resistance exercises – Tie a light sandbag to the ankle for the above exercises, usually starting resistance exercises 4-6 weeks after surgery. Start with a weight of 1 to 2 pounds and gradually increase the weight as strength is regained. Pedaling exercises – an excellent activity for regaining muscle strength and knee mobility Adjust the height of the sitting board so that the bottom of the foot just touches the pedal after the knee is straightened. Turn upside down until you feel comfortable and then step forward.
Gradually increase the wheel resistance as your strength increases (about 4-6 weeks). Practice twice a day for 10 to 15 minutes; gradually increase to 20 to 30 minutes, 3 to 4 times a week.
Pain or swelling after exercise – there may be pain and joint swelling after active exercise, elevate the affected limb and apply a cold compress wrapped in a towel to reduce the symptoms. Continued exercise will increase muscle strength and mobility. If you have any questions, contact your doctor promptly.