I. Perioperative period
1.The 1st to 3rd day after surgery
Due to the surgical trauma and a certain amount of blood loss during the operation, the patient is weak on the first postoperative day, and the wound pain is also obvious. Therefore, the patient was mainly sedated. The foot and ankle to above the knee joint were wrapped with elastic bandages with light pressure and ice packs with cold compresses to reduce bleeding and eliminate swelling. Since the knee joint tends to be mildly flexed even in normal people at rest, if the soft tissues on the posterior side of the knee joint are tight, the heel should be padded to keep the knee joint in a straight position to prevent future knee flexion contractures, and sandbag compression, knee brace or extension cast should be used to prevent flexion between training sessions and at night rest.
As the muscle contraction of the lower extremity is like a pump that continuously squeezes blood back to the heart, complete inactivity of the affected extremity after surgery can cause blood pooling and swelling in the lower extremity, resulting in deep vein thrombosis, and thrombus dislodgement can cause lung and brain infarction causing life-threatening conditions. At the same time, the complete lack of activity may cause the muscles and joints to lose elasticity and affect the recovery of limb and joint functions after surgery. Therefore, the calf should be slightly padded on the 1st to 3rd day after surgery, while doing the following rehabilitation exercises.
(1) Passive exercises (to be done by a chaperone under the guidance of medical staff)
Massage the affected limb from the foot to the thigh, 10 minutes every 2 hours
Massage the affected limb from the foot to the thigh, every 2 hours for 10 minutes
Hold the thigh and bend the knee
Flexion and extension of the ankle joint (alternating with lower limb massage), 10 minutes of activity every 1 hour
Avoid CPM exercises for the time being at this stage, as they may increase intra-articular bleeding.
(2) Active exercises (done by patients on their own)
Isometric muscle contraction exercises (in intervals with passive exercises).
Foot forceful upward hooking and downward stepping movements, 10 strokes at 1 hour intervals, each movement lasting 3 seconds
The healthy knee is flexed, the affected knee is fully extended to do the bed press, at this time the quadriceps contract, the knee joint is flattened, the patella can be slightly moved up and down, every 2 hours, one set of exercises, 30 repetitions, each lasting 10 to 15 seconds
Through this phase of exercise should achieve.
Basic elimination of swelling of the affected limb
The thigh and calf muscles of the affected limb can be coordinated to make muscle stretching and contraction movements
Relying on the gravity of the lower leg, the knee joint can be passively flexed freely without serious discomfort.
2.The 4th to 7th day after surgery
Patients can eat normally, their strength gradually recovers, wound pain begins to decrease, the blood drainage tube in the joint is removed, the swelling of the affected limb is gradually eliminated, and they can sit up in bed.
At this stage, the exercises of the first 3 days can be continued, but gradually move to fully active exercises.
Add the following exercises.
(1) Active exercises
Hold the thigh up and present a bending knee activity, 5 to 10 times every 2 hours, or lie on the bedside holding the thigh up and present a bending knee activity side by side, with the affected limb on top, and do gravity-free knee flexion and extension movements, 5 to 10 times every 2 hours.
With the help of a chaperone, sit on the edge of the bed with the bilateral lower legs naturally hanging down on the edge of the bed. If the pain is more intense you can first put a stool on the edge of the bed and rest your feet on the stool. Or lie supine on the bedside and drape the affected calf under the edge of the bed, adjusting the knee flexion by self-adjusting the position of the hip joint and the angle of abduction to complete the active flexion of the knee joint under self-control, with the angle gradually increasing.
Every 2 hours, the lower leg was suspended under the edge of the bed for about 10 minutes to actively bend the knee.
After getting used to the natural dip, sit on the edge of the bed and do the following exercises.
The foot and calf of the healthy side (or one side) press on the ankle of the affected side (or the other side) and do the downward pressure action, the foot and calf press on the ankle of the affected side and do the downward pressure action, and the foot of the healthy side (or one side) hook on the heel of the affected side (or the other side) and assist the calf of the affected side (or the other side) to do the upward lifting action; or use a bandage tied to one end of the foot and the other end held in the patient’s hand to tug the calf up and lift it by itself. The knee joint is straightened.
The foot is hooked on the heel of the affected side, the calf does the upward movement, and the hand holds the bandage tied to the foot to lift the calf by upward traction, alternating between the two, practicing 20-30 minutes every 2 hours to enhance the joint range of motion exercises (ROM exercises).
At this stage, the knee can be removed from the bed to sit on a stool or stand for adaptation with the help of a chaperone (after the trauma reaction period). Knee replacements without cement fixation should be lowered to the floor 5-6 weeks after surgery.
(2) Passive exercises
CPM exercises can be started if available, starting at 20-30° and gradually increasing the angle, 3-4 times a day for 30 minutes/time. The advantage of this exercise is that the patient is in a relaxed state during the exercise and it is easier to overcome the muscle tension caused by pain during the activity.
Several exercises can be performed alternately, and the swelling or congestion of the calf and foot surface caused by the prolapse of the affected limb is not a concern, and will gradually disappear with the postoperative recovery exercises.
Through this phase of exercise should achieve.
Strive for passive flexion of the knee joint to reach 90°, and be able to fully straighten (passive), and be able to adapt to sitting stool and standing status.
3.Postoperative day 8～14
Continue the previous phase of exercises according to the recovery situation, and further add the following exercises
(1) Straight leg raising exercises in bed, 30° can be raised to ensure straight knee and flat back, insist on 5-7 seconds, repeat 30 times, 3 to 4 times a day. Pillows can be used to help, and gradually reduce the height of the pillow. Avoid side lying abduction leg raise (straight leg raise exercise)
(2) hold the railing to do squatting exercises, squatting and insist on 5 to 7 seconds, 3 to 4 times a day, 30 times each time, gradually increase the degree of squatting
Second, the rehabilitation exercises after discharge
If the wound heals well and no serious surgical complications occur, the stitches are generally removed 10 to 14 days after surgery, and the patient’s physical condition has mostly recovered and can be discharged from the hospital. At this time, the knee function has not reached the ideal range, so the post-discharge rehabilitation exercises should still be adhered to, otherwise the previous work will be lost.