Total knee arthroplasty (TKA) is a kind of surgery with very definite efficacy, but if the success of the surgery is only based on the surgical technique without postoperative rehabilitation training, it will not be able to achieve the desired efficacy of the surgery. Through clinical practice, we have developed a postoperative rehabilitation program for total knee arthroplasty. The aim is to restore the patient’s limb function and self-care ability through early rehabilitation training. The methods mainly include preoperative guidance and postoperative training. Preoperative training Firstly, the static contraction of the quadriceps muscle of the affected limb should be strengthened, as well as the active movement of the ankle joint, each contraction of the quadriceps muscle should be kept for 10 seconds, and every 10 times should be one group, and 5-10 groups should be completed every day. The patient sits on the bed and performs straight leg raising and ankle joint resistance flexion and extension exercises, the number of times can be determined according to the patient’s own condition, repeated 2 to 3 times a day. In addition, patients should be taught how to use crutches to walk, in preparation for postoperative walking with a cane. 2. Postoperative rehabilitation training 2.1 Postoperative week 1 The purpose of this period is to reduce the patient’s symptoms, promote wound healing, prevent muscle atrophy, improve the range of motion of the joints and improve muscle strength. On the day of surgery, the functional position of the joint was maintained, and the knee was immobilized with a plaster cast and kept in the foot-high hip-low position. On the 2nd to 7th day after surgery, the affected limb should do static contraction of quadriceps muscle, holding for 10 seconds each time, every 10 times as 1 group, 10 groups per day. The patient sits on the bed, and the affected limb does straight leg raising exercise, which does not require lifting too high, but should have a lag time of about 10 seconds. Do the dorsal extension and flexion of the affected ankle joint and wrap-around movement, repeat 15 times, complete 2 to 3 groups per day. Apply continuous passive motion (CPM) machine to give the affected limb passive movement in a painless state, with a starting angle of 0° and a termination angle of 40°, for 1~2 hours a day, and try to reach or approach 90° within one week. 2.2 In the second 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 joints. Continue the activity program of the first week, CPM mobility of 90 degrees or more than 90 degrees, active knee flexion and extension exercises, see the method later. Further strengthen the straight leg raising exercise of the affected limb, a pulley can be fixed above the bed, one end of the sling is used to support the affected ankle joint, and the other end is controlled by the patient, through the assisted movement to complete the straight leg raising exercise, the patient is required to try to raise the affected limb and maintain the height, and gradually reduce the help of the hand, to the transition to the active completion of this exercise. Increase the time of activity under the bed, use the walker to contact standing and walking, and carry out gait training under the guidance of the doctor. Remove the stitches 10 to 15 days after the operation, and you can be discharged home to continue the functional exercise. 2.3 Postoperative week 3 Continue the active straight leg raising exercise to consolidate the previous training effect, restore the weight-bearing capacity of the affected limbs, strengthen the walking gait training, train the balance ability of the patients, and further improve the range of joint activities. Squatting with the help of handrails. Walking training can be carried out on a treadmill, with the patient looking straight ahead with the head up and the hips not cocked. Pedaling can be performed on a stationary bicycle with the highest cushion. During this week, the patient can try to complete daily life movements such as putting on pants and socks independently. 2.4 Postoperative week 4 to 3 months The focus is to further strengthen and improve the effect of week 3, increase the range of motion of the affected limb and weight-bearing capacity, as well as the ability to take care of themselves. The patient can walk independently on a mildly inclined slope. The patient can put on shoes, socks and pants independently. In addition to the functional training of knee bending, attention should also be paid to the functional training of knee extension, such as sitting leg press. In the early stage of walking up and down stairs, the patient mainly relies on crutches to go up and down stairs, with the healthy leg supporting and the affected limb bearing weight to partially bear weight, requiring the healthy leg to go up first and the affected leg to go down first, and the patient should get rid of the crutches when he adapts to it. Regular exercise to restore knee mobility and gradually resume daily activities is very important for your full recovery after surgery. In the early stages of recovery, your doctor should recommend that you exercise 2 to 3 times a day for 20 to 30 minutes each time and walk 2 to 3 times a day for 20 to 30 minutes each time. The following functional exercises are recommended. Early postoperative exercises If your physical condition permits, start the following functional exercises as soon as possible. You will be able to perform these exercises in the monitoring room soon after surgery. You may feel discomfort at first, but these exercises will speed up your recovery and reduce postoperative pain. Quadriceps contraction exercises Tighten your thigh muscles and straighten your knee as much as possible for 5 to 10 seconds. 10 repetitions in 2 minutes, rest for 1 minute and repeat until your thighs feel fatigued. Straight Leg Raising Exercise Lie on your back with your knee fully extended, tense your thigh muscles, raise the affected leg 15 centimeters, hold it for 5 to 10 seconds, and slowly lower it. Repeat until your thighs feel fatigued. You can also perform seated leg raises by tensing the thigh muscles and fully straightening the knee without any support. Repeat the movement. Perform these exercises periodically until thigh muscle strength is fully restored. Ankle pumping exercises Rhythmically move the ankle up and down, contracting the gastrocnemius and tibialis anterior muscles. 2 to 3 minutes for one set, 2 to 3 sets per hour. Continue until full recovery and the swelling of the ankle and lower leg has completely disappeared. Knee Extension Exercise Roll up a towel and place it behind your ankle so that your heel is off the bed, tense your thigh and try to straighten your knee as far as you can so that the back of your knee touches the bed. Hold up for 5 to 10 seconds and repeat until your thighs feel fatigued. Prone Supported Flexed Knee Exercise Maximally flex the knee with the foot sliding on the bed. Hold the position of maximum flexion for 5 to 10 seconds then straighten. Repeat until the lower extremity is fatigued or until the knee can be fully flexed. Sitting Supported Flexion Exercise Sit on the edge of a bed and chair, place the normal foot behind the affected ankle for support and slowly flex the knee. Hold in this position for 5 to 10 seconds. Repeat several times until the lower limb becomes tired or until the knee can be fully flexed. Seated Unsupported Flexion Sitting on the edge of a bed and chair, flex the knee as quickly as possible until the sole of the foot touches the floor. Shift your upper body weight forward to increase knee flexion and hold for 5 to 10 seconds. Fully straighten the knee. Repeat several times until the lower extremity feels fatigued or you are able to fully flex the knee. Early Activity Soon after surgery, you will be able to walk short distances in your hospital room and perform daily activities. Early activities help with rehabilitation and restore strength and mobility to the knee. Walking Proper walking is the best way to help you recover, and can be started with a walker or crutches. Start by using a walker or cane. Distribute your total body weight in a balanced way on the walker or cane, stand upright and relax. Move the walker or crutches a short distance forward, starting with the leg on the side of the surgery, knee straight and heel first. This way, as you move forward, your knee and ankle will flex first, and then your whole foot will step smoothly on the floor. As you finish the step, lift your toes off the floor, flex your knee and hip, and move your body forward to begin the next step. Be sure to remember the rhythm, heel first, flatten your foot and lift your toes. Walk as rhythmically and smoothly as possible without rushing. Adjust stride length and speed to achieve a steady gait As muscle strength and endurance return, gradually increase walking time and gradually increase the weight of the burden on the affected limb. You may use crutches with the opposite hand, and eventually walk completely without a cane…. When you are able to walk and stand for more than 10 minutes, your knee is strong enough to support your weight and you no longer need a walker. You can use a single crutch or cane with the hand on the opposite side of the surgery. Do not limp or lean your body toward the side of the surgery. Going up and down stairs – Going up and down stairs requires strength and flexion. At first you need to grab the handrail and go up one step at a time. Go up the step with the good leg first and down the step with the leg on the operative side first. Remember: “Good up, bad down. Have a chaperone help you with your exercises until you regain your strength and endurance. Climbing stairs is a good physical and endurance exercise. Don’t climb steps taller than 20 centimeters and hold onto the handrail for balance. When physical strength and knee mobility are satisfactory, you can climb one step at a time on your own. Post-operative exercises and activities Once you are able to walk independently for some distance and wait for a few steps, you can increase your activity level. The pain in the joint before surgery and the painful edema after surgery weaken the knee. Full recovery may take several months. The following functional exercises and activities can help you make a full recovery. Standing Knee Bend – Standing upright with the help of a walker or brace, lift the thigh and bend the knee as far as possible for 5 to 10 seconds. Straighten the knee again, heel-first, and repeat several times. Assisted knee flexion exercises – Lie on your back and fold a towel several times around the front of your ankle. Flex the knee and, pulling on the towel, slowly apply pressure to increase the degree of flexion. Hold for 5 to 10 seconds. Repeat until you feel fatigued. Knee Resistance Exercises – Tie a light sandbag around the ankle to perform the above exercises, and generally begin resistance exercises 4 to 6 weeks after surgery. Start with a weight of 1 to 2 pounds and gradually increase the weight as strength is restored. Stirring Exercises – An excellent activity for regaining muscle strength and knee mobility Adjust the height of the sitting board so that the sole of the foot just touches the pedal after the knee is straightened. Start in reverse until you feel comfortable and then step forward. Gradually increase the wheel resistance as you gain strength (about 4 to 6 weeks). Exercise twice a day for 10 to 15 minutes; gradually increase to 20 to 30 minutes, 3 to 4 times a week. Post-exercise pain or swelling-activity after exercise may have pain and joint swelling, elevate the affected limb, with a towel wrapped in a piece of ice cold compress can reduce symptoms. Continue to insist on exercise can enhance muscle strength and mobility. Contact your doctor if you have any questions. Life After Knee Replacement If you decide to have a knee replacement, you may expect your activities after surgery to be no different than they were before surgery, except for the lack of pain. In many ways, you are right. However, things don’t change overnight, and it’s important to be active and functional during the wound healing process in order to have a good surgical outcome. While many activities can be resumed after surgery, activities that put too much stress on the knee should be avoided. The following suggestions can help you adjust to your new joint and safely resume your daily activities Life in the hospital The knee is the largest joint in the body and knee replacement is a major surgery. Early activity after surgery is very important. Severe pain in the knee before surgery leads to reduced activity and thigh muscle atrophy. After surgery, you will need to regain muscle strength in your quadriceps muscles to stabilize your new knee joint. Early mobility is also important to reduce anesthetic complications and build confidence in your recovery. The level of pain after surgery varies from person to person and can be controlled by leaving a pain pump in the epidural catheter at the end of the surgery, or by oral or intramuscular pain medication. The pain will be significantly reduced in 2 to 3 days after the operation. After surgery, antibiotics should be applied intravenously to prevent infection, and anticoagulant drugs can be injected orally or subcutaneously to prevent venous thrombosis. In the first few days after surgery, you may feel nausea, lose your appetite or experience constipation. These are normal reactions. A urinary catheter will be inserted by your surgeon before surgery and may be kept in place for a few days after surgery to overcome your inconvenience in urinating. For constipation, you may take oral laxatives or apply corkscrew. You will be patted on the back frequently to expel phlegm to prevent the occurrence of pneumonia. After the operation, the lower limbs should be bandaged with thick cotton pads and elastic bandages with overall pressure, and a drainage tube should be placed inside the incision to drain out the blood and fluid accumulated in the joints. The drain is removed after 1 to 2 days. The doctor will visit you in the ward frequently and teach you how to do functional exercises. You should follow the doctor’s instructions to complete the prescribed exercise program and ask the doctor if you have any questions. On the third day after the operation, after the drain is removed, the knee joint will be placed on a CPM machine for passive movement. At other times, you should also do thigh muscle strength exercises and ankle joint rotation activities to promote the venous return of the lower limbs. Life is about movement. After arthroplasty, wounds heal through exercise and joint function is restored through exercise. Without good functional exercise, there will be no good knee function after surgery. Discharge The sutures or skin staples are usually removed 10-15 days after surgery, and it takes about 20 days from admission to discharge. The following goals are generally required before discharge: 1. To be able to get in and out of bed independently. 2, 90 degrees or more than 90 degrees. 3, The knee can be fully extended. 4.Able to walk independently, up and down stairs with correct gait. 5.No fever, no joint effusion. 6. Perform the home exercise program recommended by your doctor. There may be mild edema of the lower limbs during functional exercises at home. Elevate the affected limb after exercise, apply cold compresses to the knee wrapped in ice and wear compression stockings to reduce edema. For the first few weeks, you may need help from your family. Here are a few tips to make your home life more comfortable. Rearrange furniture to make it easier for you to use a walker. 2. Remove all rugs and other items on the floor that could trip or slip on you, and keep cords off the floor. 3. 3. Place a shower chair in the bathroom, install handles, and a toilet seat. Life at home Surgical wound care Keep the wound dry and clean If you find redness, swelling and oozing from the wound, notify your doctor Take your temperature twice a day and see your doctor if your temperature exceeds 38 degrees. Mild edema of the knee joint is normal within 3 to 6 months after surgery. It can be reduced by elevating the affected limb and applying cold compresses. Calf pain, chest pain and shortness of breath may be symptoms of venous thrombosis, please see your doctor promptly. Take your medication as prescribed by your doctor. It is important to prevent infection. Infections in other parts of the body can lead to infections around the joints. If you find an infection elsewhere in your body, you should take antibiotics. Especially if you are having dental work, tell your doctor that you have had a knee replacement and take antibiotics as a precaution. Diet Eat a normal diet with plenty of foods rich in iron and vitamin C. Drink plenty of water. If you are taking oral anticoagulants, avoid foods containing vitamin K, such as collard greens, cauliflower, liver, green beans, lentils, soybeans, soybean oil, spinach, lettuce, and onions. Return to normal life After returning home, you should still actively carry out functional exercises for at least 2 months, but you should avoid exertion. Light housework can be done. Stirring exercises can maintain muscle strength and knee mobility. Maximize extension and flexion as much as possible. Driving A car can be driven only after 6 to 8 weeks. Airport security The knee prosthesis may cause the security equipment to alarm you. You should carry a medical certificate showing that you have had a knee replacement. Sexuality 4 to 6 weeks to resume Sleeping Posture Supine, sideways and prone are fine Return to work Depending on the nature of your work, you can usually return to work in 6 to 8 weeks Other activities You can walk as much as you like, but walking is not a substitute for functional exercise. Swimming is recommended and can be done after 6 to 8 weeks. Other activities that can be done right away include dancing, golf, and bicycling. Avoid activities that put too much stress on the knee, such as tennis, badminton, competitive sports (soccer, baseball), high jumping, skiing. Do not lift or carry heavy objects.