Post-operative rehabilitation exercises should pay attention to the protection of the wound and avoid contamination, and the dressing should be disinfected and changed immediately if the wound is exposed. Exercise should start from a small amount and gradually increase or decrease according to the reaction after exercise and the next day (general condition, fatigue, local swelling and pain of the knee joint, etc.). After exercise, it is appropriate that no local pain or swelling of the knee joint occurs, and if it does, measures should be taken to relieve it within a few hours, and it should not last until the next day. Evenly distribute the amount of exercise with short intervals of rest. Short, multiple sessions of exercise per day are more effective than long sessions of exercise on alternate days. Adjust the intensity, duration and mode of exercise according to the needs of different rehabilitation stages and functional recovery at the right time.
If the pain before and after exercise is severe or if you are sensitive to pain, you can use some warm therapy and small amounts of anti-inflammatory and analgesic drugs or painkillers. Older people should exhaust their bowels before exercising, avoid exercising within half an hour to an hour after waking up from bed or immediately after waking up. Wear loose clothing and non-slip shoes when exercising, and it is best to have someone to assist with protection and provide appropriate encouragement to work together.
A combination of exercises to increase knee mobility and increase muscle strength should continue to be maintained for a long period of time, even if normal levels are achieved. Perioperative rehabilitation exercises, mainly during the postoperative hospitalization, can be performed in several stages according to the postoperative physical recovery status. (starting stage, intermediate stage, progressive stage, resumption of activity stage)
I. Postoperative day 1-3
Due to surgical trauma and certain amount of intraoperative blood loss, the patient is weak on the first postoperative day, and the wound pain is obvious, and the gastrointestinal function caused by anesthesia has not fully recovered and cannot eat. Therefore, the patient was mainly sedated. The foot and ankle to above the knee joint were wrapped with elastic bandages with light pressure and ice packs with cold compresses to reduce bleeding and eliminate swelling. Since the knee tends to be mildly flexed even in normal people at rest, if the soft tissues on the posterior side of the knee are tight, the heel should be elevated to keep the knee in extension to prevent future knee flexion contractures, and sandbag compression, knee brace or extension cast should be used to prevent flexion between training sessions and at night rest. Since the muscle contraction of the lower extremity is like a pump that continuously squeezes blood back to the heart, complete inactivity of the affected extremity after surgery can cause blood pooling and swelling in the lower extremity, resulting in deep vein thrombosis, which can cause life-threatening pulmonary and cerebral infarction if the thrombus is dislodged. At the same time, the complete lack of activity may cause the muscles and joints to lose elasticity and affect the recovery of limb and joint functions after surgery.
Therefore, the calf should be slightly padded on the 1st to 3rd day after surgery, while doing the following rehabilitation exercises.
1.Passive exercises (completed by the escort under the guidance of medical personnel)
(1) Massage the affected limb from foot to thigh, 10 minutes every 2 hours
(2) massage of the affected limb by the foot and thigh, 10 minutes every 2 hours
(3) Flexion and extension of the ankle joint (alternating with lower limb massage), 10 minutes of activity every 1 hour
Avoid CPM exercises at this stage, because it may increase intra-articular bleeding.
2.Active exercises (done by patients on their own)
Muscle isometric stretching exercises (interval with passive exercises).
(1) foot forceful upward hooking and downward stepping movements, 10 strokes every 1 hour, each movement lasts 3 seconds
(2) flexion of the healthy knee, full extension of the affected knee to do the bed press, when the quadriceps muscle contraction, knee joint flattening, patella can be slightly up and down movement, every 2 hours practice 1 group, 30 times, each time last 10-15 seconds
Through this phase of exercise should achieve.
(1) Basic elimination of swelling of the affected limb
(2) The thigh and calf muscles of the affected limb can be coordinated to make muscle stretching and contraction movements
(3) Relying on the gravity of the lower leg, the knee joint can be passively flexed freely without serious discomfort.
Second, postoperative day 4-7
Patients can eat normally, their strength gradually recovers, wound pain begins to decrease, the blood drainage tube is removed from the joint, the swelling of the affected limb is gradually eliminated, and they can sit up in bed.
At this stage, the exercises of the first 3 days can be continued, but gradually move to fully active exercises. Add the following exercises.
1.Active exercises
(1) Hold the thigh up, presenting a bending knee activity, 5-10 times every 2 hours, or lie on the bedside.
(2) Turn on your side, with the affected limb on top, and do gravity-free knee flexion and extension, 5-10 strokes every 2 hours.
(3) With the help of a chaperone, sit on the edge of the bed with the bilateral lower legs naturally hanging down on the edge of the bed, or place a stool on the edge of the bed with the feet resting on it if the pain is more intense. Or lie supine on the bedside and drape the affected calf under the edge of the bed, adjusting the knee flexion by self-adjusting the position of the hip joint and the angle of abduction to complete the active flexion of the knee joint under self-control, with the angle gradually increasing.
Drape for about 10 minutes every 2 hours.
After getting used to the natural dip, sit on the edge of the bed and do the following exercises.
(1) Press the foot and calf of the healthy side (or one side) on the ankle of the affected side (or the other side) and do a downward yo-yo movement.
(2) the healthy side (or one side) of the foot hooked on the affected side (or the other side) of the heel, to assist the affected side (or the other side) of the calf to do upward movements; or a bandage tied to the foot at one end, the other end held in the hands of the patient, self-traction so that the calf lift, knee straight. Alternate between the two, practicing 20-30 minutes every 2 hours to enhance joint range of motion exercises (ROM exercises).
At this stage, it is possible to get out of bed and sit on a stool or stand for adaptation with the help of a chaperone (after the trauma reaction period). Knee replacements without cement fixation should be placed on the floor 5-6 weeks after surgery.
2. Passive exercises
If possible, CPM exercises can be started, starting at 20-30° and gradually increasing the angle, 3-4 times a day for 30 minutes/time. The advantage of this exercise is that the patient is in a relaxed state when practicing, and it is easier to overcome the muscle tension caused by pain when moving. Several exercises can be performed alternately. The swelling or congestion and purple color of the calf and foot surface caused by the prolapse of the affected limb is not a concern and will gradually disappear with the postoperative recovery exercises.
Through this phase of exercise should achieve.
(1) strive for passive flexion of the knee joint to reach 90° and be able to fully straighten (passive)
(2) Be able to adapt to sitting and standing on the stool
Third, postoperative days 8-14
Continue the previous phase of exercises according to the recovery situation, and may further add the following exercises
(1) Straight leg raising exercises in bed, 30° can be lifted to ensure straight knee and flat back, insist on 5-7 seconds, repeat 30 times, practice 3-4 times a day. Pillow can help first, gradually reduce the height of the pillow. Avoid side lying abductor leg raise (straight leg raise exercise).
2, hold the railing to do squatting exercises, squatting and insist on 5-7 seconds, 3-4 times a day, 30 times each time, gradually increase the degree of squatting.
3.Progressive knee and ankle flexion and extension exercises
(1) slowly lift the heels at the same time until the toes are on the ground, then put back until the heels are on the ground
(2) alternate the above actions, one foot on the toe, one foot on the heel, alternating
(3) Pull both feet in turn in the direction of the hips. To let the whole foot sliding on the ground, be sure to press the floor hard and to have the feeling of tense muscles.
(4) Extend one leg forward and hook the toes. Let the leg be completely straight, and let the palm of the foot be completely on the floor when pulling back the leg
(5) Extend one leg away from the ground for some distance. Hold for 7 seconds and slowly lower the leg so that the heel lands on the ground. Then land on your feet and slowly pull your leg back, practicing 3-4 sets of 30 reps per day.