My first popular science article is to introduce knee replacement and post-operative rehabilitation. As our country gradually enters an aging society, geriatric osteoarthritis is becoming more and more common. However, the elderly are generally afraid of surgery, and because of the current shortened hospital stay, there are indeed some patients who do not achieve the expected surgical results after surgery because their functional exercises did not keep up, and the surgery was successful, but the results were not ideal. A great pity!
Knee arthroplasty should be called knee surface replacement to be exact. The surgery involves removing the damaged joint surface and replacing it with an alloy and polymer material. The goal is to relieve joint pain, improve joint function, correct joint deformity and obtain long-term stability.
The main indications include.
1, degenerative knee osteoarthritis (OA): Aged knee OA accounts for the largest proportion of total knee replacements.
2, rheumatoid arthritis (RA) and ankylosing spondylitis (AS) of the knee joint advanced lesions: RA or AS can often involve bilateral knee, joint.
3, other non-infectious arthritis caused by knee joint lesions with pain and dysfunction. Such as large osteoarthrosis, hemophilic arthritis, etc.
4, traumatic osteoarthritis: osteoarthritis after severe trauma involving the joint surface, such as cases where the joint surface fails to repair after a comminuted plateau fracture and seriously affects function, as well as secondary osteoarthritis due to meniscal injury or after resection.
5, cases with large osteochondral necrosis or other lesions of the knee joint that cannot be repaired by conventional surgical methods.
6.Joint destruction following infectious arthritis can be a relative indication for TKA if no active infection is confirmed.
7. Cases in which good joint function reconstruction cannot be obtained after resection of tumors involving the knee joint surface. Such cases may require a special customized prosthesis.
Functional rehabilitation after knee arthroplasty: Artificial total knee arthroplasty is a procedure with very definite efficacy. If you only pin the success of the surgery on the surgical technique without effective rehabilitation, you will not achieve the proper results of the surgery. For knee arthroplasty, functional exercise is as important as the surgery, as it is related to the future function and mobility of the knee.
Under the guidance of a physician, the sooner functional exercises are started, the better. Functional exercises should be based on active activities, supplemented by passive activities. It is as important, if not more important, to practice knee extension as well as flexion. It is normal to feel pain during the early activities, and it is important not to lose the best practice period (within one week after surgery) for fear of pain, which can affect the function of the knee. The purpose of postoperative rehabilitation is to restore the patient’s limb function and ability to take care of himself through early functional training. The following methods can be referred to.
Ankle pump movements: foot and ankle extension and flexion activities can be started after awakening from anesthesia, 2-3 minutes each time, 2-3 times per hour.
Quadriceps exercises: On the second day after surgery, start quadriceps exercises to maintain muscle tone. Extend the ankle joint as far as possible dorsally, straighten the knee joint and do leg lifts for 5 seconds, relax for 5 seconds and then repeat until the thigh muscles feel fatigued.
Knee lift exercises: lower limbs straight, as for quadriceps exercises, lift the leg a dozen centimeters from the bed, maintain 5 to 10 seconds, slowly lower, repeat this action until the thighs feel fatigue. You can also do straight leg raising exercises in the sitting position by contracting the thigh muscles to straighten the knee joint and hold it for 5 to 10 seconds.
Knee extension exercises: supine position, put a small pillow above the heel to make the heel suspended, contract the thigh muscles, so that the knee joint is completely straight, and try to make the back of the knee contact the mattress, maintain 10 to 15 seconds, repeat this action until the thigh muscles feel fatigue.
Leg compression exercises to straighten the function: patients with knee flexion contracture deformity, take a standing or lying position, heel placed on a soft pad of about 30 cm, their own or others hands placed on the distal end of the thigh, uniform continuous pressure to the back of the knee joint pulling sensation and pain when maintained for 3 min, alternating between the two legs, 5 times a day.
Heel slip flexion exercises: start after the drainage tube is removed. Lie on your back and make the sole of the foot slide on the bed toward the buttocks while flexing the knee to the maximum and hold it in this position for 5-10 seconds, repeating several times until the leg feels fatigued.
Sitting-assisted knee flexion exercises: Begin after getting off the floor, sitting next to the bed or in a chair, and slowly flex the knee joint to its maximum natural descent. Then move one foot to the back of the other foot and use gravitational pressure to flex the knee again as far as possible and maintain it for 5 to 10 seconds, repeating several times until the leg feels fatigued.
Early movement to the ground
On the second day after surgery, you can go down to the ground and practice standing under the guidance of the doctor. On the third to fourth postoperative day, after the postoperative inflammatory response has subsided, you can begin short-distance walking exercises. These early exercises help to regain muscle strength around the knee joint, improve joint mobility and restore balance and coordination.
Walking exercises
Correct walking is the best way to help the knee recover, starting with a walker or crutches. The first step is to feel comfortable and balanced while standing upright, then move the walker or crutches forward a small distance, straightening the knee on the operated side and moving forward, first following the foot to the ground, moving the body forward, then flattening the foot and finally releasing the toes from the ground. The walking frequency, pace distance and speed should be even. When muscle strength and endurance are increased, the walking time can be gradually extended.
Going up and down stairs
Going up and down the stairs requires strength and coordination, and is the best exercise to enhance physical strength and endurance, and requires help at first until sufficient strength and balance coordination is regained.
Squatting exercises
Squatting with weight. 50-100 times/day (as long as the knee joint is pain-free), after the joint has been flexed more than 90 degrees, start the exercise.
Postoperative rehabilitation after total knee replacement should vary from patient to patient due to their 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 pain, deformity and dysfunction of the knee, functional exercises should be performed gradually and not too quickly to avoid undue injury.