The day before the surgery: You need to prepare for the surgery by: taking a hot shower, preferably with antibacterial body wash; protecting the skin in the area of the surgery to avoid injury; not eating after 10:00 p.m. and not drinking water 6 hours before the surgery; signing the consent form for the surgery either by yourself or by asking a member of your immediate family to sign the consent form for the surgery; practicing deep breathing, quadriceps contraction, ankle pumping; practicing crutches. Surgical period (the day of surgery): Usually at around 8:00 a.m. on the day of surgery, the operating room staff will bring you into the operating room with a trolley, and your relatives can accompany you to the door of the operating room. Preparation for surgery: Inside the operating room, the operating room nurse will place the necessary devices to check your blood pressure, pulse, and respiration; set up an intravenous (IV) line; and place a tourniquet on your thigh to control bleeding during the surgery. Anesthesia: The anesthesiologist begins the anesthesia procedure and remains at your head throughout the procedure. Surgical Procedure: After disinfecting and applying sterile sheets, the surgeon will remove the damaged bone and cartilage through an incision at the front of the knee joint and implant a new joint made of metal and plastic to maintain proper alignment and function of your knee joint. The procedure takes about 2 hours from the time the skin is cut to the time the incision is closed. After surgery, you will either be moved to a recovery room to sleep for about an hour while the anesthesiology staff monitors you and then return to your hospital room, or you will be monitored by the anesthesiology staff and returned directly to your hospital room. In the early post-operative period (up to three days after surgery): i. There is a thick localized dressing on the knee (usually a bandage and cotton pads). ii. ii. There is a surgical incision drain which will be removed about 1-2 days after surgery. iii.There is an intravenous fluid line, which usually takes 3-5 days, or a blood transfusion if necessary. IV. Be careful not to stain the incision dressing when urinating or defecating in bed. If the pain is severe, ask the surgeon to give appropriate painkillers; if a pain pump is placed, use it as instructed by the anesthesiologist. Remember not to endure the pain, the doctor will have a way for you to reduce the pain. Follow the exercise methods taught by your surgeon before the surgery and start the functional exercises as early as possible. Hospitalization: about one week Pain: You will feel pain in your knee after surgery. Your doctor will give you pain relievers to make you as comfortable as possible. Deep breathing and coughing: To avoid pneumonia, breathe deeply and cough frequently to clear your lungs, at least 10 times an hour. Passive movement: In order to regain movement of your knee and lower limbs, while you are lying on the bed, your doctor will use an instrument to slowly move your knee, called the Continuous Passive Motion Exerciser (CPM), which can be used to prevent oedema, increase venous return to prevent venous thrombosis, and maintain the range of motion of the knee joint. CPM is performed for half an hour twice a day, usually after the incision drain has been removed. If your lower limbs are swollen, your doctor will treat you with an inflatable compression band or recommend you to buy special compression pantyhose; if your wound is hot, your doctor will treat you with ice packs. Foot and ankle active activity (ankle pump): it should be performed immediately after the surgery, which can promote the venous return of the lower limbs, prevent edema and thrombosis, and also increase the muscle strength so as to walk on the ground as soon as possible. Your doctor has already taught you these special methods one by one before the surgery. Drugs: According to your situation, the doctor will recommend you to use oral or subcutaneous injection drugs to prevent thrombosis, apply antibiotics to prevent infection; drugs used to treat other diseases are used as appropriate. Or take Chinese herbal medicine tablets or proprietary Chinese medicines internally to regulate all kinds of postoperative discomforts. Diet: In the first few days after surgery, you may not have a good appetite, so you need to eat a delicious and easy-to-digest diet, preferably with more iron; you may need to take some oral laxatives or eat a small amount of bananas and other fruits in order to keep your bowel movements smooth. Surgical Incision Removal: Surgical incisions may be closed with thread or staples, both of which will be removed after two weeks, or they may be closed intradermally without removal of the stitches. The incision should not be wet until it is fully healed and dry, and may be wrapped in gauze to avoid irritation. Activity and walking: Exercise during your hospitalization is vital to the recovery of function in your new joint. You will need to learn how to exercise during your hospitalization through the help and guidance of your surgeon in the surgical team to regain a near-normal range of motion in your joint. Exercise during hospitalization under the guidance of the surgeon is especially necessary because of the imperfect community health care system in China and the lack of effective rehabilitation training and guidance for many patients after discharge from the hospital. You should resume most of your normal light activities 3-6 weeks after surgery. You may experience some discomfort in the evenings after your activities, which may take a few weeks to go away. During this time you may need to use crutches or a walker to get around. Your positive attitude towards the treatment will determine the extent to which your new joint will recover its function. In general, most people can walk without crutches in 4-6 weeks. Activities should include: a gradually increasing walking program to increase your mobility and endurance, first indoors and later outdoors; resumption of other indoor activities such as sitting, standing, and walking up and down stairs; and specific exercises several times a day to maintain your mobility and to strengthen your knee (you can do this with the help of a family member or a physiotherapist, or at our Rehabilitation Department within a few weeks of your surgery). Avoiding Postoperative Complications Preventing Deep Vein Thrombosis in the Lower Extremities: Thrombosis occurs in the first few weeks after surgery, and it is important to follow your surgeon’s instructions to minimize the formation of blood clots. 1. Signs that a blood clot may form: lower extremity and calf pain unrelated to the surgical incision; pain or redness in the lower leg; swelling of the thigh, calf, ankle and foot. 2. Signs that a blood clot has entered the lungs: shortness of breath; chest pain, especially when breathing. If any of the above occurs, notify your doctor quickly. Preventing Infection: The most common cause of post-operative infections is the entry of bacteria into the bloodstream due to dental extractions, urinary tract infections and skin infections that can be located around your prosthesis to form an infection. Follow your doctor’s instructions to give antibiotic prophylaxis before dental procedures such as cleanings and other procedures that may encourage bacteria to enter your bloodstream. Possible signs of a knee replacement infection. Persistent elevated temperature; chills; redness, swelling, heat, and pain around the knee; oozing from the surgical incision; increasing knee pain with activity or at rest. Inform your doctor quickly if you have any of these symptoms. Prevent falls: If you fall in the first few weeks after surgery, you are likely to injure your new knee to the point of needing another operation. Going up and down stairs is dangerous until your knee is strong enough and mobile enough. You should use crutches, canes, handrails, or someone else to help you, and wait until you are balanced, adjustable, and strong enough to move on your own. Your doctor will tell you when you will need aids after surgery and when to stop using them. Unique to the use of your new knee, you may feel a little numbness around the incision and a little stiffness in the operated joint, especially during hyperflexion. Improving knee motion is the goal of knee replacement, but it is not easy to regain full motion. After knee replacement surgery, most patients will be able to straighten their knee and walk up and down stairs, sit in a chair, and get up from a chair. Kneeling is uncomfortable, but not harmful. Occasionally, you may feel a slight metal-on-plastic contact when you bend your knee or walk, and this abnormality will diminish over time. Most patients feel this discomfort is nothing compared to the pain and immobility they experienced before surgery. The artificial knee activates security systems, such as alarms, in airports and some buildings, so please tell the security personnel that you have an artificial knee. After surgery, you must pay attention to the following: Participate in light daily activities to maintain the strength and mobility of your new knee; Take special care not to fall or get injured, as patients with artificial knee joints will have to be reopened if they suffer another fracture; When you go to the dentist, tell the doctor that you are fitted with an artificial knee joint; Take antibiotics before each oral surgery; Take antibiotics when you have infections in other parts of your body, such as tonsillitis or ringworm infection. Antibiotics should be taken when there are infections in other parts of the body, such as tonsillitis or athlete’s foot, as the artificial knee joint is susceptible to infections after surgery; see your surgeon often for regular follow up checkups and x-rays. Regular exercise will help restore mobility and strength to your knee, allowing you to progress to daily activities and optimizing the results of your surgery. Your orthopedic surgeon or physical therapist will recommend 20-30 minutes of exercise 2-3 times a day and 30 minutes of walking 2-3 times a day. The following instructions will help you to better understand the exercise program and method, and remember to follow the instructions of your Physical Therapist or doctor. Precautions before rehabilitation exercise: 1, avoid excessive and violent force on the knee joint, it is best to complete the exercise early in the morning to prepare for daytime activities; 2, taking pain medication 30 minutes before the exercise will help; 3, master regular breathing during the exercise, exhale during the activity, inhale when you are resting, don’t hold your breath; 4, it varies from person to person, and from disease to disease. If the specified indicators can not be completed, can be completed to you think comfortable can be, step by step; 5, each time between the repetition of thinking about relaxation of the muscles, relaxation is very important; after completing the exercise will have some feeling, if the discomfort is more than 2 hours, should consider reducing the amount of practice 1, or change the way of practice; 2, practice if the problem of surgical incision, stop immediately and notify the doctor. 3.After the exercise activity, the affected limb may have pain and swelling, you can use an ice pack wrapped in a towel to apply cold compresses, then elevate the affected limb, the exercise should continue, if you have any questions, ask your orthopedic surgeon. Early postoperative exercises (up to 3 days after surgery) The following exercises should be done as soon as possible and can be started in the post-operative recovery room. They may be uncomfortable at first, but they will speed up your recovery and significantly reduce postoperative pain. Quadriceps exercises: Lie on your back with your toes pointed upward, utilize the straight leg movement, then tighten your thigh muscles so that your knee joints are close to the bed, hold for 5-10 seconds, then relax, and do this 10 times in 2 minutes until your thighs feel fatigued, rest for 1 minute, and then repeat. Straight leg raise exercise: put the leg straight on the bed, tighten the thigh muscles, as for quadriceps exercise, in this position, raise the leg 10 a few centimeters high, maintain 5-10 seconds, slowly put down, repeat this action, until the thighs feel fatigue. You can also do straight leg raises in a seated position, straightening the knee joint and contracting your thigh muscles completely without support. Repeat this exercise in stages until you regain strength in your thighs. Ankle pumps: Start in the recovery room, lying on your back and relying on your calf muscles, press the foot down and then flex it upward for 2-3 minutes at a time, 10 times an hour, and continue until you have fully recovered and the swelling in the entire calf and ankle has subsided. Knee extension: lie on your back, put a small cushion or pillow under your heel, so that you can make your heel hang in the air, contract your thighs, straighten your knee completely, and try to put the back of your knee in contact with the bed, keep it for 10-15 seconds, and repeat it until your thighs feel fatigue. Supine knee flexion exercise: lie on your back, slide the soles of your feet on the bed, make your knee bend until it can’t bend any more, in the most bent position, hold it for 5-10 seconds, repeat until your leg feels fatigued or your knee can be fully flexed. Bent knee exercise with sitting support: sit beside the bed or sit on the chair, so that the thighs have to rely on, put the healthy foot on the heel of the surgical foot for support, slowly bend the knee until the most curved. Then hold it for 5-10 seconds and repeat until the leg feels fatigued or the knee can be fully bent. Seated unsupported knee bending exercise: Sit beside the bed or in a chair and bend the knee as far as possible until the foot can be placed on the floor. Place your foot gently on the floor and lean your upper body forward as far as possible to increase the degree of knee flexion for 5-10 seconds, then straighten your knee and repeat several times until your leg is tired or your knee can be bent. Shortly after surgery, you will begin walking short distances and performing daily activities in the hospital room. These early activities will help you recover and assist you in regaining knee strength and mobility. Walking: The best way to help your knee recover is to walk correctly, and your doctor will tell you how much weight you need to put on your affected limb. You can use a walker or crutches to walk, first to be able to feel comfortable in an upright position and maintain balance, then move the walker or crutches forward a small distance, then straighten the surgical knee and move forward, so that the back of your heel can land first, and as your body moves forward, the knee and ankle will bend, and then the entire foot can be placed flat on the floor, and when you have fully completed the movement, you can be lifted off the ground by the toes. At this point the knees and hips will flex, allowing you to move forward again and begin the next step. Remember, to make the heel first, then the foot flat, and finally from the toes off the ground, walking frequency should be even and very comfortable, do not rush, to regulate the pace of the distance and speed, so that the average step, when the muscle strength and endurance progress, you can extend the walking time. When you can walk and stand for more than 10 minutes, and feel that your knee is strong enough, you can not let the walker or crutches to bear any weight (usually about 2-3 weeks after surgery), only need to use a single crutch or cane in the hand on the opposite side of the surgical knee, to be used on the opposite side of the affected limb, do not limp when you walk, do not make the healthy side of the weight alone. You can abandon the cane when you are strong enough to walk. Going up and down the stairs: going up and down the stairs requires strength and adjustability, at first you need to use the handrail to support, each time only across the first step, go up the stairs with the healthy foot first, go down the stairs with the affected foot first, remember “up with the healthy foot, down with the affected foot”, at first someone can help you, until you regain enough strength and activity. Going up the stairs is the best exercise for strong limb strength and endurance, the distance between floors should not be more than 14 centimeters, always use the handrail to keep balance, when you have enough strength and mobility, you can go up one level at a time. Further exercises and activities can be increased when you are able to walk independently for a few steps or short distances. Post-operative knee pain and swelling will weaken your knee and it will take a few months for it to recover. With the following exercises, you can expect a full recovery sooner. Standing knee flexion exercises: After standing upright with the help of a walker or crutches, bend your knee as far as you can go, then hold it for 5-10 seconds, then straighten your knee so that your foot follows the ground, then bend it again, and repeat this several times until fatigue sets in. Knee flexion exercise with support: lie on your back, wrap a towel around the front of your ankle with the ends back, grasp it with both hands, gradually and gently tighten the towel as you bend your knee, pull it back to help bend your knee, hold it for 5-10 seconds, repeat until fatigue. Knee exercises with resistance: You can add a small amount of weight to the ankle and perform the above exercises, usually 4-6 weeks after surgery, starting with 1-2 pounds of weight (such as a sandbag) and gradually increasing the weight until you regain strength. Using an exercise bike seat: Exercising in this way will help your muscles and knees move better. Adjust the seat position so that your foot is just above the pedal in the knee extension position. Pedal backward first, then forward when you feel comfortable pedaling backward. When you feel a little stronger (after about 4-6 weeks), increase the resistance to stepping forward for 15 minutes twice a day, gradually increasing to 20-30 minutes 3-4 times a day. Knee exercise against the wall: you can lean your back against the wall and gradually slide down until your knee can flex, then stand up and repeat the movement, 5-10 strokes each time, 2 times a day. After completing the artificial knee replacement surgery, I believe that you have established a close contact with the surgeon in the surgical team. The ideal recovery of the artificial knee joint function after your active rehabilitation exercise will not only enable you to enjoy a better life again, but also enable the surgeon to enjoy the pleasure of getting the results after hard work. More importantly, doctors can learn from their successes and failures and continuously improve their academic and technical skills to better serve their patients. The best way to achieve this goal is to follow up, especially at 6 weeks and 3 months after surgery.