What should be the rehabilitation treatment after total knee arthroplasty?

On the day of surgery:

1. After surgery, the affected limb is placed in the straight position, and pillows are placed under the calf and heel to elevate the affected limb to prevent swelling.

2. After the anesthesia subsides, begin to move the toes and ankle joint, and if possible, begin ankle flexion and extension activities (ankle pump exercises).

Ankle pump exercises - forceful, slow, full-range dorsiflexion and extension of the ankle joint, through the calf muscle contraction and diastole of the squeezing effect to promote the return of blood and lymphatic flow. 5 minutes / group, 1 group / hour.

3. According to the situation, start the "extracorporeal counterpulsation" treatment, in order to further promote the blood circulation of the affected limb.

Post-operative day 1:

1. Ankle pump exercise 10-15 minutes/group, 1 group/hour.

2. Isometric contraction exercises for quadriceps and hamstrings (should be done as much as possible without increasing pain).

*Quadriceps isometric exercises - i.e. thigh muscle tensing and relaxation. > 300 reps/day.

*Hamstrings isometric exercises - the affected leg is pressed down hard on the pillow, so that the muscles of the back of the thigh are tensed and relaxed. Requirements as above.

3. Start Continuous Passive Movement Exercise (CPM) 2 times/day for 30 minutes/times as appropriate.

Post-exercise ice packs for 30 minutes (after removal of cotton pads) Early completion by medical staff and gradual self-increase in angle under guidance.

4. Stretching exercises: heel pads, light load on the knee joint, 30 minutes/times, > 2 times/day.

2 days after surgery:

Continue and strengthen the above exercises

CPM: 0-60° Flexion angle is determined according to the type of surgery and the patient's own condition.

Postoperative 3 days:

Remove the drainage (according to the drainage)

1. CPM gradually increase the angle (under slight pain): if the patient's pain, swelling and temperature are good, the range of motion can be increased by 5-10°/day.

2. Straight leg raising exercise: straight leg raising after extending the knee to the point where the heel is 15㎝ from the bed, and hold it until exhaustion. 5 times/group, 2-3 groups/day. If the pain or weakness is obvious, the practice can be suspended.

3. Keep sitting position often, and don't lie down for a long time to avoid the occurrence of postural hypotension.

4. Protected standing on the floor, weight-bearing in the affected leg within the range of slight pain, walking short distances under the protection of a walker (only to go to the toilet and other essential activities). The time should not be too long. The patient's weakness is obvious, suspend the practice.

Postoperative day 4:

1. CPM exercises continue to increase the range.

2. Strengthen stretching exercises

3. Weight-bearing and balance exercises (standing center of gravity shift exercises)

4. Walking on the ground with a walker.

5 days after surgery:

1. Continue and strengthen the above exercises.

2. Walking exercises (using a walker, with protective assistance) and gradually extend the walking distance.

3. Practice using crutches

4. Positional transfer exercises: e.g. getting in and out of bed, sitting and rising from a chair.

1 week postoperatively:

1. Continue CPM exercises until you can actively flex the knee at 90°.

2. Strengthen the weight-bearing and standing exercises

3. If the flexion angle is obviously limited, passive exercises can be performed by the rehabilitation doctor according to the situation. Or under the guidance of the sitting leg drop: sitting on the edge of the bed, below the knee hanging out of the bed. Relax the thigh muscles under protection, so that the calf naturally drops, to the limit of protection for 10 minutes. Load at the ankle joint if necessary. 1-2 times/day, aiming for daily progression of the angle of flexion. If necessary, the rehabilitation doctor to give manipulation to help complete.

4. Active flexion and extension of the knee (AROM): sitting position, feet do not leave the bed. Slowly and forcefully, maximize knee flexion, hold for 10 seconds and then slowly straighten. 10-20 times/set, 1-2 sets/day.

Midterm

2 weeks postoperatively:

1. Patellar luxation (performed after suture removal): push on the edge of the patella with your hand and push the patella slowly and forcefully in up and down, left and right directions to the limit position. 20 times in each direction, 2-3 times/day. Can be practiced on your own after being taught by a rehabilitation doctor.

2. Try full weight bearing on the affected leg.

3. Passive flexion (PROM) > 100 degrees.

4. Active flexion (AROM) to 90 degrees.

Heel lifts: under protection, feet about 10 centimeters apart, support weight equally distributed between legs on both sides. Heel lift (i.e. heel off the ground, stand on toes.) To the limit, hold for 10 seconds, 30 times/group, 2-4 groups/day, rest 30 seconds between groups.

3 weeks after surgery: (Increase knee flexion angle by about 10° per week. If pain is not obvious, increase the range of motion as soon as possible.)

1. Thigh adductors and abductors exercises: start lateral leg raising exercises, 30 repetitions/set, 2-4 sets/day, 30 seconds rest between sets.

2. Bedside anti-gravity knee extension exercises: sit on the edge of the bed, below the knee naturally hanging under the bed, forcefully and slowly extend the knee to as straight as possible, hold it for 10 seconds, and slowly lower it in a controlled manner. 10-20 times/group, 2-3 groups/day.

4 weeks after surgery:

1. Standing position 0-30 internal flexion and extension exercises:

Under protection, stand with feet apart, shoulder width apart, and support the weight equally with both legs. Flex both knees at the same time to about 30 degrees, then slowly straighten. 30 times/set, 2-4 sets/day.

2. Prone position "hook leg exercise", should be static exercise, flex the knee to a painless angle and hold for 10-15 seconds. 30 times/set, 4 sets/day.

Take the sandbag as the load, in the painless range of motion, immediately after the exercise ice. If the healthy side of the leg without pain, you can choose to stand "hook leg" exercises.

3. Squatting exercises. Back against the wall, feet shoulder width apart, toes and knee joints are forward, not

"inside and outside the eight", with the increase in strength and gradually increase the angle of squatting (less than 90 °), 2 minutes / times, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day.

4. VMO exercises (last 15 degrees of knee extension anti-gravity exercises):

Sitting position, a hard pillow under the affected knee, so that the knee is in the position of 15 degrees of flexion, slowly and forcefully straighten the knee, in the position of as straight as possible to maintain 5 seconds, 30 times/group, 2-4 groups/day, 30 seconds of rest between groups.

5. Stationary bike exercises, no load to light load. 30 reps/set, 2x/day.

Later

2 months postoperative: (Achieve as much mobility as the prosthesis will allow within 2-3 months if possible)

1. Strengthening muscle strength and joint mobility exercises.

2. 2. Begin semi-squatting knee flexion and extension exercises with the affected leg in a 45° position. The affected leg stands on one leg, the upper body is straight, slowly squat to the flexion of 45 °, and then slowly pedal until completely straight. Requirements for slow, forceful, controlled (not swaying). 20-30 times / group, 30 seconds between groups, 2-4 times / day.

3. ADL exercises (up and down stairs, etc.):

STEP 10cm-15cm: choose a 10cm high step as shown in the picture to perform forward and lateral step up and down exercises. When completing the movement, use the affected leg to support your body weight and exert force slowly to experience the feeling of muscles and control the stability of joints. 30 repetitions/set, 2-4 sets/day, rest 30 seconds between sets.

3 months after surgery:

Resumption of full activity was determined after review.