As society develops and the population ages, more and more patients are having artificial knee replacements, which have been identified as a boon to most patients with knee osteoarthritis, but some patients are not getting good results for a variety of reasons and are even having serious injuries! It is very important to do a good job in the “perioperative period”.
I. Prevention of infection
Patients should be in the best physical condition before surgery, and should not have colds, toothaches, peptic ulcers, prostatitis, skin boils, foot odor, etc.
2, joint cavity puncture patients should be observed for 1 month before surgery.
3.Start 3 days before surgery, disinfect all the affected limbs with iodine volt twice a day.
4.Start intravenous antibiotics 1 day before surgery, and use another dose 20 minutes before cutting the skin.
5.Intraoperatively, use 5g of cephalosporin antibiotics in 500ml of water and rinse the key step.
6.Inject part of the antibiotic solution into the joint cavity before closing the incision to maintain the maximum concentration of drugs in the joint cavity.
7.Discontinue the catheter and epidural analgesic pump 3 days after surgery, and try not to catheterize if the surgery is not expected to last long.
8.Change the incision dressing in time and keep the incision patch dry.
9.Don’t take a bath until the incision is completely healed (usually after 1~2 months), otherwise it will easily cause incision infection. A patient I experienced went to a public bath about 20 days after surgery and developed an incision infection, which was avoided only after timely contact and proper treatment.
10. Within 6 months (or even within 2 years) after discharge from the hospital, it is still necessary to pay close attention to the treatment of infectious diseases that may exist in the body, such as colds, tooth inflammation, pharyngitis, skin boils, foot odor, gallbladder infection, enteritis, etc. Once they appear, they should be cured immediately, otherwise they may lead to inflammation of the operated joints and have serious consequences.
11.After discharge from the hospital, if you need to receive surgery for other parts of your body, it is best to contact the surgeon who performed the joint surgery for you before the surgery in order to take the necessary anti-infection measures.
II. Functional training
1. Immediately after admission, teach the patient to do functional training of toe, ankle and knee joints to enhance quadriceps muscle strength.
2. After returning to the ward after surgery (before anesthesia is removed), let the family members passively move the ankle joint 10~15 times every 15 minutes until the anesthesia of the affected limb disappears.
3. Starting from the first postoperative day, encourage the patient to actively do dorsiflexion and plantarflexion of the toes and ankle joint for 50~100 times every 30~60 minutes. This will not only help muscle recovery, but also effectively prevent blood clots.
4. Starting from the 4th postoperative day, encourage active leg lifting to restore quadriceps muscle strength, with the same frequency as the previous movement. If you can actively lift your leg out of bed during this period, you can walk on the floor.
5. Many people who practiced leg lifting well before surgery cannot lift their legs or even stack their lower limbs after surgery. This is due to damage to the quadriceps muscle (the main muscle in front of the thigh) caused by the use of a tourniquet during surgery and the surgical flip of the patella, so don’t worry! As long as a few days of training and recovery will slowly lift the thigh.
6, knee flexion training: passive knee flexion training: postoperative that is, the pillow behind the knee joint to protect the knee joint mild flexion, according to the degree of pain and patient tolerance gradually increase the height of the pillow to increase the degree of knee flexion; as the degree of knee flexion increases, you can let the patient sag the affected limb to the side of the bed to increase the range of knee flexion, or even use the healthy leg to press down on the ankle to increase the degree of knee flexion. Active knee flexion training: By 1 week after surgery, the incision pain is obviously reduced, we should encourage active knee flexion activities, and we can let the patient drag the thigh close to the body in bed to increase the degree of knee flexion; we can also let the patient sit on the bedside, with the lower leg hanging down, and do knee flexion activities.
7, knee extension training: If the postoperative knee can not be completely straight and flat should strengthen the knee straightening training, the following steps can be used to achieve: first of all, the soft tissue massage in the back of the knee for a while to keep the back of the soft tissue in a diastolic state, and then the pillow pad to the ankle, using the lower limbs of their own gravity to slowly straighten the knee; if you can tolerate it can also be in front of the knee slightly force downward pressure to increase the degree of straightening. Knee extension strength increase is to be achieved through the method of straight leg elevation (the knee will be completely straight, the affected limb elevated 45 degrees after a short pause), or the knee will be sagging bedside with the addition of the knee joint straight and parallel to the bed.
8, do not play tai chi: many of the movements of tai chi are done in knee flexion, knee flexion will reduce the contact area of the artificial knee joint surface, resulting in the concentration of force on the prosthesis, which can easily damage the joint; in addition, the rotational movements of tai chi will increase the rotational activities of the femoral artificial joint, which also increases wear and tear. If the knee joint is replaced after often playing tai chi will certainly affect the life of the artificial joint.
9, do not do extreme sports: Although the design of the artificial joint is increasingly in line with the needs of the human body, but more than the extreme movement of the joint can also damage the joint. Such as extreme squatting, cross-legged, splitting movement in daily life are not suitable. For an elderly person with an artificial joint replacement, as long as the joint can be fully extended and the knee can reach 90 degrees of flexion, it is sufficient for daily life!
10. Keep the surgical incision dry: When the surgical incision scab is not completely fallen off, you cannot take a “bath” to avoid contaminating the wound with raw water and causing post-operative infection.
Some normal “abnormal” phenomena
11. Dullness, numbness or loss of sensation in the skin on the outside of the knee. This is because the surgical incision of the artificial knee joint cuts the skin nerve that supports the lateral side of the knee, which does not have any effect on the function of the knee joint.
12. Postoperative fever around the incision. About 1 month after the operation, there is an obvious feeling of local heat in the knee joint (rheumatoid patients have more obvious heat in the knee joint after the operation), and even feel the local high temperature through the underwear. This is due to the postoperative incision tissue repair blood circulation, with the incision repair local skin temperature will gradually return to normal.
13. Activity rattle. This is due to the patella and femoral condyles touching each other; or it is due to the activity of the artificial joint components, which does not affect the use of the joint. In some cases, the joint rattles when the person gets up and just gets off the ground, and then stops rattling after walking a few steps.
14. Uncoordinated activity. In the period just after surgery, patients find that the knee joint is inflexible or even difficult to extend when they first get up and get off the floor, but after a few steps of walking, their gait improves significantly and they move freely. This is the process of recovery from foreign body sensation to proprioception as people adapt to the knee prosthesis in the body.
15. The limb is lengthened. This is due to the surgery to correct the original deformity, changing the lower limb force line, giving people the feeling that the limb on the side of the surgery is lengthened when walking, as long as after a few months of walking training will be able to adapt, and slowly feel the double lower fat equal length.
16, fear of squatting. After knee replacement people restore the normal walking function, but in extreme squatting (such as squatting to the toilet) often have the feeling of falling backwards, which is due to the process of removing the rear part of the ligament.
17.Can’t walk backwards.