Total knee arthroplasty is a highly effective procedure, but if the success of the surgery is based on the surgical technique without effective rehabilitation, the surgery will not be as effective as it should be. For total knee arthroplasty, functional exercise is as important as the surgery, as it relates to the future function and mobility of the knee. Under the guidance of a physician, functional exercises should begin as early as possible and should be based on active activities, supplemented by passive activities. It is normal to feel pain during the early activities, so you should not be afraid to move for fear of pain and lose the best practice period (within one week after surgery), which will affect the functional rehabilitation of the knee joint after surgery. Post-operative rehabilitation (exercise) guidance for total knee replacement includes: muscle training, gait correction, psychological adaptation and whole-body training, etc.
1. Early exercise (0-7 days after surgery)
The knee joint is in a slightly flexed functional position, and ice packs are applied for 24 hours. 6 hours after surgery, muscle functional exercises are started, such as quadriceps static contraction training, knee extension and elevation exercises, ankle extension and flexion exercises, etc.; the drainage tube is removed on the 2nd-3rd postoperative day, and the venous lymphatic circulation therapy device of the lower extremity is performed to prevent venous thrombosis after the drainage tube is removed, and partial weight-bearing walking with the assistance of a walker is possible on the third postoperative day.
2.Mid-term exercise (8-14 days after surgery)
Gradually increase the weight-bearing of the affected knee, but still should be partially weight-bearing with crutches and increase the sitting flexion exercises.
3.Later exercise (15-21 days postoperative)
The focus is on gradually restoring the weight-bearing capacity of the affected limb, starting walking and gait training, and strengthening the patient’s balance. Further strengthen the muscle strength enhancement training of quadriceps and N cord muscles, adopt isotonic, isometric and isometric muscle strength training methods, and conduct stair training.
4.Cautions for home exercise
①Continue to do knee flexion, extension and muscle rehabilitation exercises even after going home.
②Keep the wound clean and dry. You can take a shower four weeks after surgery. It is normal to have numbness on the outside of the incision after surgery.
③In case of tooth extraction, cold or other diseases, you should tell your doctor that you have had your knee joint replaced so that antibiotics can be given to prevent infection.
④In general, after surgery, do not put full weight on the affected limb for six weeks and do not use crutches after three months.
⑤After six months, you can swim, play golf and other mild sports, but avoid strenuous sports such as jumping, squatting, racing, tennis and basketball.
⑥Please follow the physician’s instructions and return to the clinic for regular checkups if you have any of the following conditions, such as redness, swelling, pain, or abnormal purulent discharge from the wound.
5.Walking exercise precautions
Proper walking is the best way to help the knee joint recover, and it is necessary to start walking with the help of a walker or crutches. First of all, you should feel comfortable and be able to maintain your balance when standing upright, then move the walker or crutches forward a little distance, straighten the knee joint on the operated side and move forward, first make the foot follow the ground, move the body forward, then flatten the foot, and finally the toes leave the ground. Walking frequency, pace distance and speed should be even, when muscle strength and endurance are increased, you can gradually extend the walking time.
6, up and down the stairs precautions
Going up and down the stairs requires strength and coordination, and is the best exercise to enhance the strength and endurance of the limbs, which requires help at the beginning until sufficient strength and balance coordination is regained.
7.General requirements for rehabilitation (exercise)
Rehabilitation after total knee arthroplasty should vary from person to person due to the patient’s physical condition, medical condition, psychological quality, subjective requirements, and surgical procedure. In addition, since patients who receive total knee replacement have a history of long-term knee pain, deformity and dysfunction, functional exercise should be done gradually and not too quickly to avoid undue injury.
(1) quadriceps static contraction training: the patient lies flat, the lower limb is straight, the affected limb do quadriceps static contraction dimension, hold for 5 seconds and then relax, 10 times as a group, four groups a day.
(2) knee extension and elevation exercises: lower limb straight, as for quadriceps exercises, lift the leg off the bed a dozen centimeters, hold for 5-10 seconds, slowly put down, repeat this action until the thighs feel fatigue, three times a day.
(3) Ankle extension and flexion exercises: the patient lies flat on the bed, the muscles are relaxed, keep the knee joint straight, the ankle joint does 1 plantar flexion and dorsiflexion at a uniform speed as 1 group, keep 8-10 groups per minute, do 3-5 minutes each time, three times a day.
(4) Seated flexion exercises: sit on a chair, put a towel under the joint, straighten the leg as much as possible, maintain the action, hold it for 5 seconds, then flex the knee as much as possible, maintain the action, hold it for another 5 seconds, keep repeating.
(5) Up and down stairs training: In the early stage, mainly rely on crutches and the lower limb of the healthy side to support up and down stairs, gradually transition from non-weight bearing to partial weight bearing of the affected limb, the healthy side goes up first and the affected side goes down first during training, gradually reduce the dependence on crutches after the patient gets used to it, and finally be able to walk independently without crutches.