Total artificial knee arthroplasty (TKA) is a very accurate operation with a postoperative excellent rate of >90%, but the success of the operation can not be achieved without postoperative rehabilitation training. Through clinical practice, we have developed a rehabilitation training program after artificial total knee arthroplasty. The purpose is to restore the patient’s limb function and self-care ability through early rehabilitation training. The main methods are preoperative guidance and postoperative rehabilitation training.
1. Pre-operative guidance
First of all, we should strengthen the static contraction exercise of the quadriceps muscle of the affected limb and the active movement of the ankle joint, requiring each contraction of the quadriceps muscle to be maintained for 10 seconds, and every 10 times is one group, and 5 to 10 groups are completed every day.
The patient should sit on the bed and perform straight leg raising exercises and ankle joint resistance flexion and extension exercises, the number of times can be determined according to the patient’s condition and repeated 2 to 3 times a day.
In addition, the patient should be taught how to use crutches to prepare for walking with a cane after surgery.
2.Post-operative rehabilitation training
(1) The first week after surgery
The purpose of this period is to reduce the patient’s symptoms, promote wound healing, prevent muscle atrophy, improve joint range of motion, and increase muscle strength.
①On the day of surgery, maintain the functional position of the joint, fix the knee joint with a plaster pallet, and maintain the foot-high hip-low position.
②On the second to seventh postoperative day, the affected limb did static contraction of the quadriceps muscle, holding it for 10 seconds each time, and every 10 times was one group, 10 groups per day.
③Patients sit on the bed and do straight leg raising exercise for the affected limb, without requiring the lifting height, but with a lag time of about 10 seconds.
④Do the dorsiflexion movement of the affected ankle joint, keeping that joint at 90°, and do the wrap-around movement of that joint repeated 15 times, completing 2 to 3 times a day.
⑤Apply continuous passivemotion (CPM) machine to give passive motion of the affected limb in a painless state with a starting angle of 0° and a termination angle of 20°, completing a round trip within 2 min for 4 hours per day, and trying to reach or approach 90° within 1 week.
(6) Low-frequency modulated medium-frequency current was applied to the affected limb twice a day, with current density not exceeding 0.3mA/cm2 to improve local blood circulation and promote wound healing.
(2) The 2nd week after surgery
Focus on strengthening the active movement of the affected limb without weight-bearing and improving the active range of motion of the joint.
①Use Maitland’s technique level I to loosen the joint in a small rhythmic back and forth from the starting end of the joint movement in the pain-free range of the affected knee.
②The patient sits on the bed and completes 2.2.1 autonomously with the hip as the fixed point and the slide board placed under the affected foot and using it as the moving point.
③Further strengthen the straight leg raising movement of the affected limb. A pulley can be fixed above the bed, with one end of the sling holding the ankle joint on the affected side and the other end controlled by the patient to complete the straight leg raising movement through assisted movement, requiring the patient to raise the affected limb as high as possible and maintain the height, and gradually reduce the help of the hand to transition to the active completion of this movement.
④ Encourage the patient to get out of bed. In the first half of the week, the patient practiced standing in the parallel bar under the action of the plaster pallet, at this time the center of gravity was on the healthy side and the affected side was not weighted to the ground; in the second half of the week, the center of gravity gradually transitioned to the affected side until the plaster pallet was released and the patient stood upright in the parallel bar.
(5) Increase the angle of CPM machine to 90°~100°.
(3) The third postoperative week
Continue the active straight leg raising exercise to consolidate the previous training effect, restore the weight-bearing ability of the affected limb, strengthen the walking gait training, train the patient’s balance ability and further improve the range of motion of the joint.
①After removing the plaster brace, in order to understand the patient’s balance ability, let the patient stand and the therapist push the patient back and forth, and pay attention to whether the patient can maintain his or her own balance.
②Patients practice walking with crutches, and when they are psychologically and physiologically able to do so, they walk inside the parallel bars without crutches.
③Patients lying on their side with the affected limb on top, straighten the knee joint to do abduction movement, ankle joint at 90°, on the basis of this do back and forth swinging exercises, therapist in the opposite direction of the application of resistance, the patient needs to overcome resistance.
④Maitland maneuver level IV.
⑤In prone position, active flexion of the affected knee joint can also be done with the help of the therapist.
⑥Bend the knee joint under the action of the quadriceps trainer, starting from 90° with a weight of 1 kg, twice a day for 15 min.
(vii) Walking training on a treadmill with the patient looking forward with the head up and the chest out, without the hips cocked.
⑧Pedaling on a stationary bicycle with the cushion starting from the highest.
⑨Patients should try to do daily activities such as putting on pants and socks independently during this week.
(4) Postoperative week 4 to 3 months
Focus on further enhancing the results of the 3rd week, increasing the range of motion and weight-bearing capacity of the affected limb, as well as the ability to take care of oneself.
①Walk independently on a mildly inclined slope.
②Independently put on shoes, socks, pants and other activities of daily living.
③In addition to functional training for bending the knee, attention should also be paid to functional training for knee extension, such as leg press in sitting position.
④Reliance on crutches to go up and down stairs in the early stage, with the healthy leg supporting and the weight-bearing to partial weight-bearing below the affected limb, requiring the healthy leg to go up first and the affected leg to go down first, and then disengage from the crutches after the patient has adapted.
3.Cautions
①When using low-frequency modulated medium-frequency current to act on the affected limb, the therapeutic electric flow cannot be the tolerated amount, and the standard of 0.3mA/cm2 should be strictly followed to avoid tissue damage.
②Prevent infection after surgery, and apply antibiotics systemically or locally.
③Inquire about the patient’s condition and any local discomfort before daily training to understand the size of the exercise volume, and pay attention to the results of the floating patella test, and pump and decompress if the floating patella test is positive.
④The training volume should be small to large and progressive, so as not to cause discomfort in the affected knee.
The above is the training procedure we have developed after total knee arthroplasty. After the patient goes home, he/she should also insist on training according to the above requirements, and contact the rehabilitation doctor and the surgeon to regularly check and evaluate the function of the affected knee.