I. Rehabilitation exercises for the first three days after surgery During the first three days after surgery, the patient may seem weak due to the trauma of the surgery, intraoperative bleeding and the gastrointestinal function caused by anesthesia, which has not yet fully recovered. At the same time, they may feel some pain in the wound and some swelling of the skin on the operated side of the thigh. Therefore, patients should focus on rest and recuperation during this phase. Avoid heavy exercise. When the patient returns to the ward from the operating room after surgery, he or she will find the bed cleaned up, with a triangular-shaped pillow and a special pair of “thong” shoes. These are specially designed to prevent joint dislocation after surgery. After surgery, the patient must maintain the affected limb in an abducted neutral position. This is done by lying flat on the bed with a soft pillow under the operated limb so that the hip joint can be slightly flexed and a triangular pillow placed between the two thighs so that both knees and the toes of the feet are up. Absolutely avoid inversion and internal rotation of the affected hip. There is no need to be alarmed by heavy sweating, etc. It may be due to the fact that the front half of the bed can be gradually elevated on the second day after surgery, taking a semi-sitting position (30~45 degrees), paying attention to the fact that the sitting time should not be too long, starting with 5 minutes and gradually increasing to 15~20 minutes. If you feel dizziness, panic, vomiting, or the patient has been lying in bed for too long and is not comfortable with the semi-sitting position. At this time, you can do deep breathing, and after half a minute if the symptoms are reduced, you can continue the semi-sitting position for 5 minutes; if the symptoms are aggravated, you should immediately lie flat and rest. In most cases, these uncomfortable symptoms will be relieved after lying down. 2, ankle pump exercise action essentials lying flat on the bed, keep the knee straight, foot as far as possible upward hook, hook to can no longer hook when hold the position for 5 seconds, then relax for 10 seconds, continue to step down, the same in can no longer step when hold for 5 seconds. Repeat 20 times every 2 hours. When doing the movement, the patient will feel the muscles of the leg being tensed. The purpose of this exercise is to prevent the development of deep vein thrombosis in the lower limbs. As we know, the muscle contraction of the lower limb is like a “pump” that squeezes the blood back to the heart. After surgery, if the affected limb does not move, it can make the veins of the lower limb stagnate and swell, causing deep vein thrombosis. Once the thrombus is dislodged, it may cause heart, lung, brain and other important organs infarction and cause life-threatening. 3, lower limb massage method from the affected side of the back of the foot to start the centripetal massage, that is, first the sole, then the calf, and finally the thigh order. Each massage 10 minutes. Massage once every 2 hours. Massage should be gentle, and pay attention to the protection of the wound and the surrounding area, so as not to cause unnecessary pain to the patient. Lower limb massage can be done by the patient’s family or accompanying help. The purpose of massage is to promote blood circulation in the lower limbs and reduce the incidence of deep vein thrombosis in the lower limbs. At the same time, massage can also reduce pain and increase the patient’s sense of security. 4.Activities of the healthy side of the lower limb Generally, on the second day after surgery, if the patient is in good general condition, he can practice the activities of the joints. The activities of the able-bodied limb include the ankle, knee and hip joints. Method: Lie down or half sit on the hospital bed and practice the ankle, knee and hip joints in turn. The patient can decide the amount of exercise according to his or her feeling during the exercise process. Patients who are young, in good health before surgery and have no postoperative complications can increase the intensity of exercises appropriately. The usual way to increase the intensity of the exercise is to have the patient put a sandbag over the ankle joint (the weight of the sandbag is decided according to the specific situation of each individual), or to have the patient be accompanied by medical personnel or apply a resistance to the patient in the opposite direction of the exercise (e.g., if the patient flexes the ankle joint, an artificial resistance is applied over the ankle joint so that the patient can feel the presence of a certain resistance when flexing the ankle joint). ). 5.Muscle strength exercises of the affected limb Muscle strength exercises include three methods: isometric contraction exercises, isotonic contraction exercises and isometric muscle strength exercises. Early after surgery, especially within three days, it is recommended that patients do isometric contraction exercises. After the artificial total hip replacement, the following isometric contraction exercises for the muscles are required. These exercises will strengthen the patient’s thigh and calf muscles and reduce swelling. Don’t worry, such exercises do not increase pain because the joint does not move while the muscle strength is being practiced. Muscle strength exercises require persistence, which is something that tests the patient’s perseverance. If you do it only three or five times a day, the effect will definitely not be obvious. (1) Quadriceps exercises: The quadriceps muscle is located on the front side of the thigh, it can fix the patient’s knee joint and also help to move the knee joint. The thinner thighs of patients who are bedridden for a long time are mainly due to the atrophy of the quadriceps muscle. Therefore, the strength of this muscle should be practiced early after surgery. Specific method: lie flat on the bed, tense the thigh muscles, keep the knee joint straight, and force the knee joint to the direction of the bed, feel already with their maximum force, hold this position for 5~10 seconds, then relax for 5 seconds, repeat 10 times, try to do 5~10 times per hour. (2) Gluteus exercise method: clench the hips, contract both hips together, hold for 5 seconds, then relax for 5 seconds, 5~10 times per hour. Patients are advised to do this exercise whenever they want to. This is because the patient has nothing else to do in the early postoperative period. (3) Gastrocnemius training: The gastrocnemius muscle is located at the back of the calf. Specific method: keeping the knee joint straight, the patient’s ankle joint is first shaded and flexed, and the heel is pulled backward, then the ankle joint is put in dorsiflexion position, so that the heel is pushed forward. Only after the muscles of the lower limbs become hard and the muscle strength is strong, getting out of bed and walking will become very easy. Second, postoperative day 4~7 rehabilitation exercise Starting from the fourth postoperative day, the patient can already eat normally, the pain is gradually reduced, and the strength is getting better day by day. The drainage tube placed in the wound has been removed. More and stronger exercises can be performed at this time. At this stage, the patient can still continue with the three muscle strength exercises methods described earlier. Because as discussed earlier, the strength of the postoperative lower limb muscles is very important for later walking on the ground, and the exercise of muscle strength is a long-term process, do not expect that the muscle strength can reach a high level in one or two days of exercise. 1.CPM functional exercise On the 4th day after surgery, the patient can eat and urinate and defecate normally, the original catheter and wound drainage tube have been removed, and the pain and swelling of the wound have been reduced significantly, the patient will feel that the original surgery is not as terrible as imagined before surgery. At this point, the surgeon will give the patient a device called CPM. This machine helps the patient to very gently flex and straighten the joint on the operated side. One thing that many patients who have used this device have felt is that the pain disappears or is reduced when they move the joint with this machine. The patient’s statement is completely correct, as numerous studies have proven the following effects of CPM after artificial joint replacement: (1) Prevention of joint stiffness and improvement of joint range of motion. (2) Reduces pain. (3) Reducing swelling. (4) Reducing the incidence of lower extremity venous thrombosis after surgery. The doctor may keep the patient on this machine during hospitalization. In some hospitals, CPM can also be rented to patients for a period of time when they are discharged from the hospital. 2. Passive movement of the hip joint Some passive exercises can be performed in bed to move the artificial hip joint from the fourth day after surgery. Passive movement is the movement done with the help of medical staff, family members or the non-operated side of the limb. The main methods of movement are: (1) Passive movement of the hip joint using a bandage or the force of the non-operated leg. The bandage is about 2 meters long, one end of the bandage is placed on the bottom of the foot, the other end is held in both hands, using the strength of both hands, the lower limb is lifted off the bed, pay attention to the initial lifting distance from the bed should not be too large. If you don’t have a bandage, you can also hold the ankle joint of the healthy side against the affected ankle joint, and then lift it upward with force, holding it for 5-10 seconds when it reaches the highest point. (2) If your body is still weak and you don’t have the strength to finish moving the affected hip with a bandage or your healthy leg passively, it doesn’t matter. You can try the following method: fold a towel into a small round roll, place it under the affected knee joint and keep the hip and knee joint in flexion (the number of degrees required is the same as above) for 30 minutes. Repeat 3 times a day. (3) If your hospital has the conditions, you can ask a special rehabilitation doctor or therapist to help you move your joints after surgery. (1) The lower limbs should be fully relaxed so as not to cause significant pain. (2) Move gently and slowly, and the range of motion should be from small to large, with the maximum not exceeding 90 degrees. (3) Avoid hip joint inversion and rotation. 3.Knee training Pillow under the knee of the affected side, take the knee as the fulcrum, let the affected knee press downward, lift the lower leg upward away from the bed to do knee extension, and keep it in the air for 10 seconds, put it down slowly, repeat 10~20 times. Starting from the 4th day after surgery, you can move your body outward to the bedside with the help of the nurse or rehabilitation therapist, and let the lower leg hang naturally over the bedside so that the knee joint bends to 90 degrees. In the process of moving, pay attention to avoid rotation of the affected hip. 4.Hip lifting exercise Starting from the fourth day after surgery, lift the upper body by supporting both elbows with the help of family members or holding the hoop above the bed with both hands, while lifting the hip off the bed, hold for 10~15 seconds and repeat 5~10 times. 5.Reclining to sitting training Reclining – sitting transfer training: The patient lies flat on the bed with the affected limb in an external booth. Let the patient flex the lower limb on the healthy side, straighten the affected limb, and use both hands to support the half sitting up. Using both hands and the support of the healthy side, move the hip to the affected side, and then move the affected lower limb and upper body. Repeat the above movements to move the patient to the bedside of the affected side. The therapist stands at the bedside of the affected side, holds the patient’s affected limb with one hand, holds the patient’s shoulder with the other hand, and watches the patient support the bed with both hands and the healthy limb at the same time, and sits up with the hip as the axis of rotation. Take care that the hip flexion should not exceed 90 degrees. Let the patient’s feet drop and sit on the edge of the bed. If the patient finds it difficult to drop the feet, put a low stool at the bedside, put the feet on the stool, and then remove the stool when the feet get used to dropping. Observe the patient for any discomfort, and pay attention to the patient’s heart rate and blood pressure. If it is too difficult to go directly from lying to sitting and the patient cannot do it easily, it does not matter, you can start training from semi-recumbent position: ask the nursing staff to raise the head of the bed 30 degrees first, and then sit up with the method just taught. This will be much easier. Reclining to sitting training is a prerequisite for standing and walking, and is very important because the patient must first be able to sit up before being able to stand and walk on the floor. However, this training may be difficult for patients who have just undergone surgery. Patients should do this with the help of a nurse or rehabilitation therapist, not on their own, and even if they think they are strong enough, they should at least have a health care provider on hand to guide them the first time they do this exercise. The biggest risk of this training is the dislocation of the artificial hip joint. Therefore, it is still important that there is no rotation of the hip joint and that the flexion does not exceed 90 degrees during the training. In addition, when the patient is sitting at the bedside, if there is any uncomfortable situation such as panic, sweating, nausea, vomiting, etc., he/she should tell the medical staff around him/her immediately. Rehabilitation exercises in the second week after surgery The focus of the second week after surgery is to strengthen the active movement of the affected lower limb without weight-bearing, improve the range of motion of the joint, further improve muscle strength and increase the ability to move independently in bed. 1.Hip flexion exercises Active hip and knee flexion and extension exercises on the affected side within the pain-free range, the degree of hip flexion is 45-60 degrees (lateral approach incision) or less than 30 degrees (posterior approach incision) 2.Strengthen the strength training of the muscles around the affected hip within the pain-free range (1) Quadriceps training methods are: ①Straight leg raise with assistance: install a fixed pulley above the bed, use one end of the sling to hold the ankle, the other end the patient The other end is held by the patient, and the straight leg raise is completed with the help of hand assistance. The number of straight leg raise is 30 degrees, hold each movement for 10 seconds, repeat 20~30 times, and gradually reduce the hand assistance, and transition to active straight leg raise. ② Active straight leg raise exercise, the same method as before. (2) Hip abductor training Let the patient straighten the foot and extend the affected limb in the right neutral position to the outside, and then return to the neutral position of the body. Note that the affected limb should always keep the foot straight, with the knee joint and toes outward. 3.Continue to strengthen the bedside position transfer training, i.e., lying-sitting transfer training, sitting horizontal movement training, sitting-standing transfer training. The method is the same as the first few days after surgery. Pay attention to avoid moving the body to both sides in the process of conversion. 4.Standing exercises After overcoming postural hypotension, practice standing balance on the side of the bed (or in the balance bar) with the support of the healthy leg, and keep the healthy leg standing alone for 5-10 minutes, without putting weight on the affected leg at this time. Rehabilitation exercises in the third week after surgery In the third week after surgery, generally speaking, the wound sutures have been removed, so the patient can choose to continue rehabilitation exercises at home or go to a special rehabilitation center. The focus of rehabilitation in this stage is to continue to consolidate the previous training effect, improve the self-care ability of daily life, gradually restore the weight-bearing ability of the affected leg, and strengthen gait training. 1. Air bicycle activity Do 20~30 times of air bicycle activity with both lower limbs in supine position, and limit the degree of hip flexion to 90 degrees or less. Every 10 times is a group, with one minute rest in between. This can improve the range of motion of the joints of the lower limbs and also train the muscle strength of the quadriceps. 2.Hip training The patient stands, grasps the handle of the bed rail or chair with both hands, flexes the knee on the affected side and gradually raises the affected leg. Be careful that the knee joint is not higher than the hip, and keep the knee joint forward and the body not forward. The lower extremity is straightened and pushed backward to the back of the body. Be careful not to bend the body forward. 3.Walking training Perform walking training with the assistance of a walker. Let the patient hold the walker and practice walking with the weight of the affected limb not exceeding 20 kg in the third week. pay attention to correct the walking posture during walking. When turning, if you turn to the affected side, let the affected limb take a step outward first, then move the walker and then follow the healthy limb; if you turn to the healthy side, let the healthy limb take a step outward first, then move the walker and then follow the affected limb.