The purpose of artificial total knee replacement (TKR) is to relieve knee pain, correct knee deformity, improve the functional status of the affected knee, and thus improve the patient’s quality of life.Rehabilitation activities after TKR can maximize the improvement of prosthetic knee function.The appropriateness of postoperative rehabilitation after TKR not only has a great impact on the surgical effect, but also directly affects the recovery of the patient’s knee function. Postoperative rehabilitation exercise precautions Since the knee joint function is mainly reflected in the joint mobility and quadriceps and N cord muscle strength, the main content of postoperative rehabilitation is the exercise of joint mobility and quadriceps and N cord muscle strength exercise. In addition, in order to cooperate with walking and recovering physical strength, physical strength recovery exercise can be carried out incidentally. If the pain is serious or sensitive to pain before or after the exercise, some warm therapy can be used, and anti-inflammatory and analgesic drugs or painkillers can be used in small quantities. Elderly people should exhaust the urine and feces before exercise, to avoid waking up half an hour to an hour after sleep or get up immediately after exercise. Exercise should wear loose clothing and pants and non-slip shoes, it is best to have someone to assist in the protection, and be properly encouraged to work together with efforts. The combination of exercises to increase knee mobility and muscle strength should be maintained for a long period of time, even if normal levels are achieved. The artificial knee joint has a flexion limit, the current design of various prostheses is basically between 110 to 135 °, generally after rehabilitation exercises can reach about 110 ° can get more satisfactory daily activities. If there are some special circumstances such as surgical installation problems, you should listen to the doctor’s advice. In conclusion, the degree of knee flexion that can be achieved in rehabilitation training and after rehabilitation is based on the product design flexion limit, and should not blindly pursue a larger degree over the range, otherwise it may cause joint damage 1. Perioperative rehabilitation exercises are mainly for postoperative hospitalization, and can be divided into several phases according to the postoperative recovery status of the body. (Beginning stage, intermediate stage, progressive stage, resumption of activities stage) (1) Postoperative days 1 to 3 Because of the surgical trauma and a certain amount of intraoperative blood loss, the patient is weaker on the first day of the postoperative period, and the pain of the wound is more obvious; the gastrointestinal function caused by the anesthesia has not been fully restored and cannot eat; at the same time, the blood accumulated in the joint cavity still needs to be induced through the retained drainage tube. Therefore, the patient is mainly sedated. The ankle to above the knee joint is wrapped with an elastic bandage with slight pressure, and an ice pack with cold compresses to reduce bleeding and eliminate swelling. Since even normal people tend to have mild knee flexion at rest, if the soft tissues of the back side of the knee are tight, the heel should be elevated to keep the knee in the straight position to prevent knee flexion contracture in the future, and sandbags should be used for compression between training and at night when resting, and the knee brace or straightening cast should be used to prevent flexion, which should be used continuously for 6 to 8 weeks after the operation in general. As the muscle contraction of the lower limbs is like a pump that constantly squeezes the blood back to the heart, complete inactivity of the affected limbs after the surgery can cause blood pooling and swelling in the lower limbs, resulting in deep vein thrombosis, and dislodgment of the thrombus can cause life-threatening pulmonary and cerebral infarction. At the same time, complete inactivity can make the muscles and joints lose elasticity, affecting the recovery of limb and joint function after surgery. Therefore, the lower leg should be slightly elevated on the first to third days after surgery, and the following rehabilitation exercises should be done: ① Passive exercises (completed by the accompanying personnel under the guidance of medical personnel) Massage the affected limb from the foot to the thigh for 10 minutes every 2 hours Massage the affected limb from the foot to the thigh for 10 minutes every 2 hours Flexion and extension of the ankle joints (alternating with the massage of the lower limbs), and 10 minutes of activity every 1 hour Avoid CPM exercises for the moment, as it may increase the flexibility of the joints, which may result in the loss of muscle and joint flexibility. CPM exercises should be avoided at this stage because they may increase intra-articular hemorrhage. ② active exercises (patient-driven) muscle isometric contraction exercises (and passive exercises at intervals): the foot force to do the upward hook and downward stepping movement, every hour 10, each action lasts 3 seconds the healthy knee flexion, the affected knee is fully straightened to do the bed pressure action, this time, the quadriceps contraction, knee spreading, the patella can be slightly up and down movement, every two hours of practice, a group, repeat 30 times, each time lasts 10 ~ 15 seconds Through this stage of exercise should achieve: basic elimination of the swelling of the affected limb, the thigh and calf muscles of the affected limb can be coordinated to exert force to make muscle contraction movement, rely on the gravity of the calf, the knee joint is passive and free to flex without serious discomfort (2) Postoperative days 4 to 7, the patient has been able to eat normally, the physical strength is gradually recovered, the pain of the wound has begun to reduce, the blood drainage tube in the joints has been removed, the affected limb is gradually eliminated, and the affected limb can be sat up in the bed. At this stage, you can continue the exercises of the previous 3 days, but gradually over to fully active exercises. Increase the following exercises: ① active exercises, hold the thigh upward, knee flexion activities, every 2 hours 5 ~ 10, or lying on the side of the bed, sideways, the affected limb on the top, do gravity flexion and extension of the knee joint movement, every 2 hours 5 ~ 10 In the accompanying personnel to help, sitting on the side of the bed, bilateral calves naturally hanging down the side of the bed, such as the pain is more severe can be put on the side of the bed first in a stool, the foot rests on the stool. Or lie on the bedside, hang the affected side of the lower leg under the edge of the bed, adjust the degree of knee flexion through self-adjustment of the position of the hip joint and the angle of abduction, in order to complete the active flexion of the knee under self-control, and the angle is gradually increased. Every 2 hours hanging about 10 minutes after the natural sagging habit, sitting on the edge of the bed to do the following exercises: the healthy side (or one side) foot and calf pressure on the affected side (or the other side) on the ankle, to do the downward yo-pressing movement healthy side (or one side) foot hooked on the affected side (or the other side) heel, to help the affected side (or the other side) calf to do the upward movement; or a bandage tied to one end in the foot, and the other end of the patient’s hands, self-traction to make the calf lift, and the other end of the leg to make the calf lift. The other end of the bandage is held in the patient’s hand, and the patient can pull the calf up and straighten the knee. Alternate between the two, practicing 20-30 minutes every 2 hours to enhance joint range of motion exercises (ROM exercises). At this stage, you can get out of bed and sit on a stool or do adaptive standing with the help of a chaperone (after the trauma reaction period). Knee replacement without cemented fixation should be done 5-6 weeks after surgery. Several kinds of exercises can be performed alternately, and the swelling or purple congestion of the lower leg and foot surface caused by the drooping of the affected limb is not to be worried about, and will disappear gradually with the resumption of the postoperative exercises. Through this stage of exercise, you should achieve the following: Strive for passive knee flexion to reach 90°, and be able to fully straighten (passive) Adapt to sitting on a stool and standing (3) Post-operative days 8 to 14 According to the recovery situation, continue the previous stage of exercise, and can further increase the following exercises. ① Straight leg raising exercises in bed, 30° can be raised to ensure that the knee joints are straight and the back is spread, hold on for 5-7 seconds, repeat 30 times, 3-4 times a day. Pillows can be used first, and the height of the pillows can be gradually reduced. Avoid side-lying adductor leg raising (straight leg raising exercise) ② hold the railing to do squatting exercises, squatting, adhere to 5 to 7 seconds, 3 to 4 times a day, 30 times each time, gradually increase the degree of squatting ③ progressive knee and ankle flexion and extension exercises slowly and simultaneously lift the heel until the toe of the ground, and then put back until the heel of the ground Alternately practice the above movements, a toe on the ground, a foot on the ground, alternately changing the accompanying staff to help walker exercises flat Under the guidance of the accompanying staff, practice walking on a level road with a walker and a weight of about 10 kg on the knee, 3 to 4 times a day for 10 to 20 minutes each time. Perform the above exercises on your own or under the guidance of the medical staff by reasonable arrangement, alternating between the daytime and the daytime. Through this stage of exercise, you should achieve the following: active knee flexion of 90 ° or more, active straightening, and sitting. Rehabilitation exercises after discharge If the wound heals well and no serious surgical complications occur, the stitches are usually removed 10 to 14 days after the operation, and the patient’s physical condition has mostly recovered, so the patient can be discharged from the hospital. At this time, the knee function has not reached the ideal range, so the rehabilitation exercises should still be insisted after discharge, otherwise, the previous work will be wasted.