Disease guidelines & Preoperative preparation & Postoperative rehabilitation for knee replacement

JUST College is committed to the multi-dimensional popularization of precautions for daily use of joints, correct understanding of joint diseases, pre-operative preparations and post-operative rehabilitation. Through the way of entertaining and entertaining, patients benefit a lot.

Disease guidelines

Reasons for knee replacement

1. The knee joint is one of the largest joints in the body. It is composed of the femur, tibia and patella. It is the weight-bearing joint of the human body and one of the most vulnerable joints. Common factors that lead to knee pain and restricted mobility: The most common are osteoarthritis, rheumatoid arthritis and traumatic arthritis.

1) Osteoarthritis: It is common after 50 years of age, and there is often a family history of arthritis. In this type of arthritis, the articular cartilage and meniscus used as bearing are often worn away, and the joint space becomes smaller, resulting in painful friction, joint deformation and stiffness.

2) Rheumatoid arthritis: It can cause inflammation of the synovial membrane of the joints and produce excessive joint effusion; inflammation can also erode and destroy the articular cartilage, causing joint pain, deformation and stiffness.

3) Traumatic arthritis: Intra-articular fractures can directly destroy articular cartilage.

Preoperative preparation

Preparing for knee replacement surgery

1) Take a hot bath;

2) Protect the skin of the surgical area to avoid injury;

3) Stop eating after 10 o'clock at night, and stop drinking water 6 hours before surgery;

4) You or entrust your immediate family to sign the operation consent form;

5) Practice deep breathing, quadriceps relaxation and contraction, ankle pump exercises; practice crutches; practice urination on the bed.

6) Exercise (under the guidance of a doctor)

The best physical condition is an important condition for the success of the operation: strengthening the upper limb muscles will help you to use crutches after surgery. Enhancing the muscle strength of the lower limbs will help Sudan recovery time.

7) Medical examination

Before the operation, you need to do a medical examination to determine your physical condition and discover some negative factors that are not conducive to the operation or recovery. For example, dental treatment-although the chance of infection after hip replacement is very low, bacteria can still be transmitted through the bloodstream. Therefore, any dental treatment should be performed before surgery.

8) Delay taking some drugs

The doctor will tell you which drugs (including prescription drugs) must not be taken before surgery.

9) No smoking

Avoid lung problems after surgery and promote early recovery.

10) control weight

For obese patients, weight control will reduce the pressure on new joints.

11) Routine inspection

Routine blood and urine, cardiac ultrasound, chest X-ray, and chest X-ray are the items that must be checked before surgery.

12) History of allergy

Any possible allergic reactions, including allergies to drugs, metal fibers, etc., must be notified to facilitate further in-depth preoperative examinations and to determine alternative drug treatments or other types of replacement surgery.

Postoperative rehabilitation

Rehabilitation training after knee replacement  

The first day after surgery: Remove the plasma drainage tube and urinary tube in the morning, and use a walker to guide the patient to get out of bed and walk. In the afternoon, guide the patient to get out of bed again, and teach the patient to get out of bed, go to bed, and move correctly. Strengthen the muscles of both lower limbs. At the same time, patients should be given psychological support. The higher the enthusiasm of the patient, the faster the recovery.

1) Ankle dorsiflexion: Active maximum flexion and extension of the ankle joint and resistance training. Hold each action for 5 seconds, repeat 20 times/group, 2-3 groups a day.

2) Quadriceps training: do static contraction of the quadriceps, hold for 5 seconds each time, every 20 times/group, 2-3 groups/day; at the same time, the patient can do straight leg raising exercises on the bed, no The height is required to be raised, but there must be about 5 seconds in the air; slowly bend the knee and bend the hip to slide the heel of the affected limb to the hip, keeping the toe upward to prevent the hip from adduction and internal rotation. 3) Resistance training: resistance adductor and resistance abduction isometric training, each movement is held for 5 seconds, repeated 20 times per group, 2 to 3 groups per day.

On the 2nd to 3rd day after operation: the patient should be more active, while strengthening the ankle dorsiflexion, plantar flexion and quadriceps training. On the 4th to 14th day after operation: the patient's fluid infusion was stopped, and the focus was on muscle strength exercise and increased joint activity. At discharge, hip flexion reached 70°～90°, abduction of 15°, and external rotation of 10°. Teach patients to walk with crutches and arrange a rehabilitation training plan after discharge. During this period, you should also perform supine straight leg elevation and knee flexion hip flexion training. And strengthen posture transfer training and joint mobility training. 2nd to 3rd weeks after operation: In addition to the above training, strengthen hip flexion, abduction, and external rotation. The training method must be correct to prevent joint dislocation. Train patients to walk on crutches. 4 weeks to 3 months after surgery: daily functional training should be carried out, and patients should be taught how to go to the toilet, put on and take off shoes and socks, ride in a car, and go up and down stairs. Patients who have not had a greater trochanteric osteotomy should abandon crutches and walk around 6 weeks. At the same time, patients should be asked to review regularly to prepare patients for their return to society.

Patients who are discharged from the hospital under hip replacement surgery should still pay attention to the following issues in their daily lives:

1) Sitting position: The sitting time in the first month after surgery should not be too long to avoid hip joint edema. Cold compress and raising the affected limb can also be used to improve it. Keep the knee joint lower than or equal to the hip. It is not advisable to sit too low. Chairs, sofas, do not cross your legs and ankles, do not bend forward more than 90 degrees, lean back and stretch your legs forward when sitting.

2) Going to the toilet: Use a heightened self-made toilet to go to the toilet, or with the aid of the body, lean backward and stretch out the affected leg to the toilet. Keep the knee joint higher than the hip.

3) Retrieving objects: Do not bend over to pick up objects on the ground within 2 weeks after the operation. Do not suddenly turn around or reach out to retrieve objects behind you. You should put your rice bowl in front of you when you eat.

4) Ride: Sit forward at the hip position, lean back, and stretch your legs forward.

5) Shower: After the wound is healed, the auxiliary can be used for showering. Because standing showering is dangerous, you can sit on a high stool. The spray head is a movable hand-held spray head, and a bath sponge with a long handle is prepared to be able to Touch the lower limbs and feet.

6) Putting on and taking off shoes and socks: ask others for help or use shoehorns, choose elastic shoes and loose trousers that do not tie up. Those who have a posterolateral incision can carry their shoes inside, and those who have an anterior medial incision can carry their shoes outside.

7) Physical activities that can be carried out after a complete recovery: walking, gardening, cycling, bowling, table tennis, swimming, dancing, and maintain a proper weight. Avoid activities that put excessive pressure on the new hip joint and cause wear and tear, such as jumping, running, skiing, water skiing, tennis, etc.

Special note: The range of motion of the new joint is limited. Patients need to pay special attention to avoid joint displacement, including:

*Avoid crossing your legs and knees when sitting, standing, or lying down.

*Keep your feet 6 inches apart when sitting.

*Keep your knees below hip level when sitting. Avoid sitting in chairs that are too short. You can sit with pillows to keep your knees below hip level.

*When standing up from the sitting position, slide to the edge of the chair, and then stand up with a walking frame or crutches.

*Avoid bending over. Patients may consider buying long-handled shoe flaps or soft shoes so that they can put on and take off their footwear without bending over.

*When lying down, place a pillow between your legs to keep the joints in place.

*Use a special abduction bracket or splint to fix the hip joint in place.

* Raise the toilet position so that the knee is kept below the hip when going to the toilet.