Total knee replacement is one of the larger knee surgeries, and there may be discomfort such as fever and pain after surgery. However, good function comes to a large extent from timely and correct rehabilitation functional exercises. Therefore, postoperative functional exercises should be performed as early as possible under the guidance of a physician to overcome fear, inertia and other adverse emotions. 1. The methods and data provided in this plan are formulated according to the general routine, and the specific implementation should be completed under the guidance of doctors depending on their own conditions and surgery. 2. A certain degree of pain is unavoidable in functional exercises. If the pain can subside to the original level within half an hour after the exercise stops, it will not cause damage to the tissue and should be tolerated. 3, muscle strength exercises should be concentrated until the muscle has a sense of soreness and fatigue, and then proceed to the next group after sufficient rest. The number of exercises, time, load depending on their own situation, and should be practiced at the same time the healthy side. Good muscle strength is a key factor in joint stability and a guarantee of good knee function and must be practiced carefully. 4.In addition to the proper braking protection of the operated limb, the rest of the body parts (such as the upper limb, waist and abdomen, and the healthy side of the leg) should be practiced as much as possible to ensure physical quality, improve the overall level of circulation and metabolism, and promote the recovery of the operated local. 5.Joint mobility (flexion and extension) exercises strive to improve the angle each time. If the flexion angle does not progress for a long time (>2 weeks), there is a possibility of joint adhesions, so great importance should be attached to it and insist on completing the exercises. 6, mobility exercises are generally given immediately after the ice 15-20 minutes. If you usually feel swelling, pain and fever in the joint, you can apply ice again, 2-3 times a day. 7.The side with shadow in the appendix is the affected side. 8.The swelling of the joint will accompany the whole exercise process, and it is normal that the swelling does not increase with the angle exercise and activity, until the angle and muscle strength basically return to normal, the swelling will gradually subside. The sudden increase of swelling should adjust the practice and reduce the activity, and the follow-up should be done in time when it is serious. Early 1. On the day of surgery: (1) Place the affected limb in a straight position after surgery, with a pillow under the calf and heel to elevate the affected limb to prevent swelling; (2) Start moving the toes and ankle joint after anesthesia subsides, and if possible, start ankle flexion and extension activities (ankle pump exercises). Ankle pump exercise – hard, slow, full-range flexion and extension of the ankle joint to promote blood and lymphatic return through the squeezing effect of calf muscle contraction and diastole. 5 minutes/group, 1 group/hour; this exercise is important to prevent swelling and deep vein thrombosis and promote blood circulation of the affected limb, and should be practiced carefully; (3) Start “extracorporeal counterpulsation” treatment according to the situation. Extracorporeal counterpulsation” treatment should be started according to the situation to further promote blood circulation in the affected limb. 2. 1 day after surgery: (1) ankle pump exercises for 10-15 minutes/group, 1 group/hour; (2) isometric contraction exercises for quadriceps and N cord muscles (should be done as much as possible without increasing pain), quadriceps isometric exercises – i.e. thigh muscle tensing and relaxation. >(1) isometric exercises for the quadriceps femoris – that is, tensing and relaxing the muscles of the posterior thigh. (3) Start continuous passive motion exercises (CPM) 2 times/day for 30 minutes/time as appropriate. Adjust the machine to the slowest speed to reduce the number of flexion and extension, each flexion and extension angle should be in place and held at the maximum angle of flexion for 10-30 seconds, gradually increase the range of motion when the patient can tolerate it comfortably, if the patient has less pain can be held at the maximum angle of flexion for 5 minutes before the end of treatment. Ice packs for 30 minutes after the exercise (after removal of the cotton pad) are done early by the medical staff and gradually increase the angle on their own under guidance; (4) Extension exercises: padding at the heel, light load added to the knee joint, 30 minutes/time, >2 times/day. 3. 2 days after surgery: Continue and strengthen the above exercises. CPM: 0-60° Determine the flexion angle according to the type of surgery and the patient’s own condition. 4.3 days after surgery: Remove the drainage (according to the drainage). (1) CPM gradually increase the angle (under slight pain): if the patient has good pain, swelling and temperature, increase the range of motion by 5-10°/day; (2) straight leg raising exercises: straight leg raising to 15M from the bed after knee extension, hold until the force is exhausted. 5 times/group, 2-3 groups/day. If pain or patient’s weakness is obvious, exercise can be suspended; (3) frequently maintain sitting position, do not lie in bed for a long time to avoid the occurrence of postural hypotension; (4) stand on the ground under protection, bear weight within the range of slight pain in the affected leg, walk short distances under the protection of walking aid (only for activities necessary for life such as going to the toilet). Do not take too long. The patient’s weakness is obvious. 5.Day 4 after surgery: (1) CPM exercises continue to increase the range; (2) strengthen stretching exercises; (3) weight-bearing and balancing exercises (standing center of gravity shift exercises), weight-bearing and balancing – separation of the feet under protection, alternating between left and right moving the center of gravity within the range of minimal pain. 5 minutes / time, 3 times / day; (4) separation of the feet back and forth, moving the center of gravity. 5 minutes/time, 3 times/day; (5) Walk on the ground with a walker. 6.5 days after surgery: (1)Continue and strengthen the above exercises; (2)Walking exercises (using a walker, with the help of protection), and gradually extend the walking distance; (3)Practice using crutches; (4)Postural transfer exercises: such as getting in and out of bed, sitting up and down on a chair, etc. 7. 1 week after surgery: (1) Continue CPM exercises until you can actively flex the knee at 90°; (2) Strengthen weight-bearing and standing exercises; (3) If the limitation of flexion angle is obvious, passive exercises can be performed by the rehabilitation doctor according to the situation. Or perform seated leg drops with guidance: sit squarely on the edge of the bed with the knee suspended below the bed. Relax the thigh muscles under protection and let the lower leg drop naturally to the limit for 10 minutes. If necessary, add load to the ankle joint. 1-2 times/day, aiming for daily progress in flexion angle. (4) Active knee flexion and extension exercises (AROM): sitting position, foot does not leave the bed. Slowly and forcefully, flex the knee to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day. Third, mid-term 1, 2 weeks after surgery: (1) patellar release (performed after stitch removal): hand push push the edge of the patella, push the patella slowly and forcefully in the up and down and left and right directions to the limit position. 20 times in each direction, 2-3 times/day. Can be practiced by yourself after being taught by a rehabilitation physician; (2) Try full weight bearing on the affected leg; (3) Passive flexion (PROM) >100 degrees; (4) Active flexion (AROM) up to 90 degrees. Heel lift exercise: Under protection, feet are separated by about 10 cm, and the supporting weight is equally distributed between the legs. Lift the heel (i.e., heel off the ground and stand on your toes.) To the limit, hold for 10 seconds, 30 times / group, 2-4 groups / day, 30 seconds rest between groups. 2. 3 weeks after surgery: (Increase the knee flexion angle by about 10° per week. If the pain is not obvious, increase the range of motion as soon as possible.) (1) Thigh adductor and abductor exercises: start side leg raising exercises. 30 times/group, 2-4 groups/day, rest 30 seconds between groups; (2) Bedside anti-gravity knee extension exercises: sit squarely on the bedside with the knee joint hanging naturally below the bed, forcefully and slowly extend the knee until it is as straight as possible, hold for 10 seconds, and slowly lower it in a controlled manner. 10-20 times/group, 2-3 groups/day. 3. 4 weeks postoperatively: (1) 0-30 internal flexion and extension exercises in standing position: under protection, feet apart, shoulder-width apart, legs evenly distributed to support weight on both sides. Both knees should be flexed to approximately 30 degrees at the same time and then slowly extended. 30 times/group, 2-4 groups/day; (2) Prone position “leg hook exercise”, should be practiced statically, bend the knee to a painless angle and hold it for 10-15 seconds. 30 times/group, 4 groups/day; (3) Static squat exercise. Back against the wall, feet shoulder-width apart, toes and knees are forward, no “internal and external eight”, gradually increase the angle of squatting (less than 90 °) with increasing strength, 2 minutes / time, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day; (4) VMO exercises (the last 15 degrees of knee extension anti-gravity exercises): sitting position, the affected (4) VMO exercise (last 15 degrees knee extension anti-gravity exercise): sitting position, a rigid pillow under the knee, put the knee in a flexed 15 degrees position, slowly and forcefully straighten the knee, hold it in the straightest possible position for 5 seconds, 30 times/group, 2-4 groups/day, rest 30 seconds between groups; (5) stationary bicycle exercise, no load to light load. 30 minutes/time, 2 times/day. Fourth, the late 1, 2 months after surgery: (as far as possible in 2-3 months to achieve the mobility allowed by the prosthesis) (1) strengthen muscle strength and joint mobility exercises; (2) start the affected side single leg 45 ° position half squat flexion and extension knee exercises. The affected leg stands on one leg with the upper body upright, slowly squats to the 45° of flexion, and then slowly pedals until fully straightened. 20-30 times/group, 30 seconds between groups, 2-4 times/day; (3) ADL exercises (up and down stairs, etc.): STEP 10 cm-15 cm: (see Appendix 1 – Figure 24, 25) that is, choose 10 cm high steps as shown for forward and lateral stepping exercises. Note that when completing the movement, use the affected leg to support the weight and exert force slowly to experience the muscle sensation and control the stability of the joint. 30 times/group, 2-4 groups/day, 30 seconds rest between groups. 2.3 months after surgery: After review, it is determined that full activities can be resumed. V. Remarks: 1. Flexion exercises: Choose any one of the following methods. Once a day, aim for a slight increase in angle. If you have any special discomfort during or after the exercise, you should inform the doctor in time. Exercise process shall not be straightened rest, repeated flexion and extension, otherwise it will affect the effect, and very easy to cause swelling. (1) sitting (or supine) position hanging leg: sitting on the edge of the bed lying down, below the knee hanging outside the bed. Relax the thigh muscles under protection, so that the calf drops naturally, to the limit of protection for 10 minutes. If necessary, add load at the ankle joint. (2) supine draped leg: supine on the bed, thighs perpendicular to the bed, under the protection of relaxed thigh muscles, so that the calf naturally drops, the requirements of the same as above. (3) sitting position “top wall”: sitting on the chair, the affected side of the toe against the wall or fixed, slowly move the body forward to increase the angle of bending the knee, feel the pain and keep still, a few minutes after the pain disappears or lower, and then move forward to the limit. The whole procedure is controlled within 30 minutes. (4) Active flexion and extension exercises: (performed after passive flexion) Sitting position, the foot does not leave the bed. Slowly and forcefully, flex the knee to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day. 2, extension and flexion of the exercise method: stretching exercises in the muscles and posterior joints of the pulling sensation and slight pain is normal, do not contract the muscles against, should be completely relaxed, otherwise the effect will be affected. The weight of the load used in the exercise should not be too large, should make the affected knee dare to relax, last up to 30 minutes, there is a clear pulling sensation is appropriate. No rest should be taken in the middle of the exercise process, otherwise the effect will be affected. (1) Seated knee extension: Sitting position, foot pads high, weight above the knee joint. Relax the muscles completely and hold for 30 minutes. 30 minutes/time, 1-2 times/day. (2) Prone suspension: prone, below the knee suspended outside the bed, weighted at the ankle joint. Requirements as above. (3) Active stretching: Hold at the limit for 10 seconds, relax for 5 seconds. 20-30 reps/group, 1-2 groups/day.