Artificial knee replacement is a new technique for treating knee diseases that has gradually developed after the successful application of artificial hip joints to patients in recent times. It is very effective in eradicating advanced knee pain and greatly improves the quality of life of patients, and is more popular in developed countries.
What are the precautions for artificial total knee replacement?
1. What position should a patient under epidural anesthesia take after surgery?
Patients should lie down with the pillow removed after epidural anesthesia surgery and fast for 6 hours with no food and water.
2.What position should a patient under general anesthesia take before he/she is fully awake?
Patients under general anesthesia should lie down with their heads tilted to the side before they are fully awake to prevent complications such as airway obstruction or aspiration pneumonia caused by vomitus being inhaled into the airway by mistake. At the same time, fasting and water fasting should be done for 6 hours.
3.What position should the patient take after total knee arthroplasty?
When the patient returns to the ward after total knee arthroplasty, the affected limb should be elevated with a special lower limb pad to facilitate blood return to the affected limb to prevent edema. The distal end of the affected limb (toe) should be above the level of the heart while the proximal end (thigh) should be slightly below the level of the heart; the knee joint should be flexed 5°-10° to prevent common peroneal nerve paralysis; (patients with post-stabilized total knee prosthesis can be placed in extension without considering nerve injury); the ankle joint should be flexed 90° with the heel hanging in the air to prevent compression.
4.What conditions should the patient and family find on the postoperative day that should be promptly notified to the health care staff?
When the patient or family members find pain, swelling, numbness, lowered skin temperature at the end of the limb, tight fixation after plaster fixation, skin pressure pain especially at the ankle joint, heel and inner thigh, they should contact the medical staff immediately for timely treatment.
5.How to prevent venous thrombosis of the lower limbs?
Deep vein thrombosis is one of the complications after knee surgery, and the prevention and treatment measures are as follows
(1) Drug prevention: The doctor will choose the drug and time according to the patient’s condition.
(2) Device prophylaxis.
(1) application of a plantar venous pump to promote blood return to the lower extremity.
(ii) Continuous sitting for no more than 45 minutes at a time.
(iii) Ankle pump exercise.
(4) Elevate the affected limb.
6. Importance of functional exercises for patients after total knee surface replacement
①Strengthen the muscle strength of knee flexors and extensors through muscle strengthening exercises and promote the recovery of whole body strength and condition.
②Improve the muscle strength around the knee joint and its soft tissue balance and coordination through walking or other coordination training to ensure joint stability.
③Through joint mobility training, the range of motion of the knee joint can meet the needs of daily life movements and partial participation in social activities.
④Prevent postoperative joint adhesions, improve local or whole lower limb blood circulation, and avoid certain postoperative complications through active and passive knee joint activities.
⑤ Improve the patient’s spiritual and psychological outlook and stimulate enthusiasm for life.
7.Principles of post-operative rehabilitation training for artificial knee joint replacement
①Individualization principle: Since different patients have different physique, condition, psychological quality, subjective functional requirements and surgical procedure, it should be different from person to person.
②Comprehensive training principle: the knee joint is only one of the walking weight-bearing joints, such as rheumatoid arthritis often involves multiple joints and organs, therefore, dealing with the knee joint alone is not enough to improve the patient’s function, artificial knee arthroplasty rehabilitation training must take into account other parts of the body.
The principle of gradual progress: Patients who undergo knee replacement have long-term pain, deformity and dysfunction, and the soft tissues, muscles and bones around the knee joint are invaded, so the patient’s level of function can only be gradually improved.
8. Under what circumstances should post-surgical rehabilitation be contraindicated
① High fever, body temperature higher than 38 degrees Celsius.
②Heart rate greater than 100 beats/min at quiet time.
③ joint effusion or inflammation.
④Symptoms of hypotension with systolic blood pressure less than 13.33 kPa (100 mmHg).
⑤ having symptoms of hypertension with diastolic blood pressure greater than 16 kPa (120 mmHg).
⑥fracture, swelling, oozing from the incision and poor healing
(7) Severe dysfunction of vital organs such as heart, lung, liver, kidney and brain, requiring absolute silence from the perspective of medical treatment.
The above precautions are not absolute, and passive exercise and muscle immobilization training can still be performed appropriately, but only with full consideration of the systemic condition and under medical supervision.