Artificial knee arthroplasty has now become an important tool in the treatment of disfiguring knee lesions caused by various diseases, but if the success of the surgery is pinned on the surgical technique without postoperative rehabilitation, the surgery will not be as effective as it should be. Rehabilitation after artificial knee arthroplasty has become an integral part of the surgery. The prevention of postoperative complications, improvement of knee range of motion and restoration of walking ability are achieved through continuous passive motion exercises in the early postoperative period, unassisted exercises for joint mobility, walking exercises, physical factor therapy, and quadriceps muscle strength training in the late postoperative period, making the final efficacy of the surgery a high level.
I. Rehabilitation assessment
The postoperative rehabilitation assessment of the artificial knee joint is important for guiding and adjusting the rehabilitation program and evaluating the final treatment effect.
The assessment includes.
1. assessment of the muscle strength of the quadriceps and N cord muscles.
2. Assessment of knee joint condition: degree of knee deformity, soft tissue balance, local bone condition, etc.
3.Post-operative position evaluation of the artificial knee joint.
4. Knee function score.
II. Rehabilitation goals
1.Prevent complications of long-term bed rest: deep vein thrombosis, pressure sores, lung infection, urinary tract infection, etc.
2.Improve and restore the range of motion of the knee joint and reduce knee pain.
3. To restore the patient’s ability to perform independent activities of daily living and improve the quality of life through walking training as soon as possible.
III. Treatment procedure
1.On the day after surgery, the heel is padded and the affected limb is elevated for rest to avoid pressure sores.
2. On the 1st postoperative day, perform isometric contraction exercises for the quadriceps and N cord muscles. Elevate the affected limb at rest.
3.On the 2nd – 4th postoperative day, continuous passive movement exercises, initial range of movement 0-45°, 2 times a day for 1 hour each time. And perform joint mobility exercises.
4.On postoperative day 5–6, start balance and coordination exercises, and downward standing exercises.
5.On the 7th day after surgery, practice walking with the help of double crutches or walker.
6.In the 2nd postoperative week, CPM flexion and extension were gradually increased to 0°-90°, aiming to reach 90° knee flexion range within 2 weeks after surgery. Perform isotonic contraction muscle strength exercises for quadriceps and rouge muscles with apparatus resistance, functional bicycle exercises, and practice walking up and down stairs as appropriate.
7.In the 3rd week after surgery, increase squatting exercises.
8.3–6 weeks after surgery, mainly enhance muscle strength, and continue joint mobility exercises, while continuing to improve walking ability and full weight bearing.
IV. Training methods
1.Quadriceps isometric exercises
Supine or sitting position, knee straightened, maximum strength isometric contraction of quadriceps without increasing pain.
2. Isometric exercises for the N cord muscle
Supine or seated position, knee straight or slightly flexed, as much as possible without increasing the pain isometric contraction of the N cord muscle.
3.Knee extension exercise
Sitting or supine position. Heel pads are elevated and the lower leg and knee joint are left empty for 20 – 30 minutes. If necessary, add weight to the knee.
4.Straight leg lift exercise
Supine position, straighten the knee joint as much as possible and lift the straight leg. After the strength is increased, change to sitting position. The exercise can be reinforced by adding an appropriate amount of load to the ankle joint.
5.Patella release
Push the edge of the patella with the finger belly or palm root and slowly push the patella in four directions: up, down, left and right. 10–20 times in each direction, 2–3 times/day.
V. Evaluation and education
Pre-discharge evaluation and education.
Bilateral lower limb muscle strength, knee mobility, walking ability, knee function score, etc. were assessed before discharge. Teach the patient the home training program, emphasize the postoperative movements and positions to be avoided, and return to the hospital for rehabilitation once or twice a week for 3 months.