1. The nursing staff will assist and guide you to get out of bed the next day after the artificial knee joint surgery.
2. If the surgical site is red, swollen, oozes, has fever, or is in pain and unable to move, please return for examination.
3. Need to use assistive device to get out of bed and use progressive movement.

 

1. Electrocardiography(ECG;EKG), blood analysis, plain radiographs of the chest and the knee.
2. Anesthesia risk assessment before surgery and consent signature.
3. Sign the surgery consent after the interpretation and discussion with the surgeon.
4. The night before surgery, nursing staff will provide you enema to clean the intestine.
5. The day before or on the day of surgery, bathing with soap or a body wash containing antibacterial agents can effectively reduce bacterial colonies on the skin and reduce postoperative wound infection.
6. Do not have food or water for 8 hours before surgery.
7. In the morning of surgery day, the nurse will in dwellings venous catheter on your arm to facilitate the administration of drugs.

1. Doctor will assess the situation to put a wound vacuum drainage tube, the nurse will assist and tell you how to keep the drainage tube unobstructed. If there is a drainage tube at the wound, it must be placed on the same side of the surgical site.
2. For wound pain after surgery, the doctor will prescribe oral painkillers for you to take regularly; if the pain does not improve after taking the painkillers for more than 1 hour, please inform the nurse to evaluate your condition and use other painkillers if necessary . Taking painkillers must pay attention to slow down and avoid bending over, so as not to cause dizziness and fall due to postural hypotension.
3. On the first day after the operation, depending on the recovery situation, a nurse or rehabilitator will assist you to use a walker to get out of bed; you should also shake the head of the bed when eating to avoid choking.
4. After surgery elevated your limb, like put the pillow under your leg may subside swelling. To keep the knee in full extension (Figure 1), do not put the pillow under your knee (Figure 2).

   Figure 1（Correct）	Figure 2（Incorrect）

5. Please tell the nurses for assistance if you feel pain.
6. On the first day after surgery, the rehabilitator will teach rehabilitation exercises to avoid muscle deterioration and joint stiffness so that you can get out of bed and walk before go home. You need to take rehabilitation exercises, such as quadriceps setting exercise, ankle pumping exercise, and straight leg raising exercise. These exercises are illustratedas follows:

   Figure 3

   Quadriceps setting exercise(figure3): lying on the bed, contract and hold your front thigh muscle, make your knee straight and contact the bed. Hold this posture for 5 seconds.

   Figure 4

   Ankle pumping exercise (figure 4): while doing quadriceps setting exercise, dorsally flex your foot simultaneously. This can help strengthen the limb muscles.

   Figure 5

   Straight leg raising exercise (figure 5): lie down and place the knee straight on the bed, then lift the lower limb off the bed with knee fully extended.

7. Depending on how you bend.The nurses will help you how to start knee flexion exercise by machine (figure 6). The nurses will also tell you the way to start knee flexion exercise when sit on the edge of the bed (figure 7).
8. The nurses or rehabilitator will tell you how to use the crutches, walker or wheelchair to get out of bed and walk.
9. You should not take shower or use the bathtub until the stitches have been removed.

1. Please take knee flexion exercise everyday to increase range of motion of the knee underwent the surgery.
2. You should walk with walker or crutches until the doctor tells you that they are no longer necessary.
3. Please decrease ambulation and elevate your legs if they swell after walking.
4. You should avoid violent exercises in order to prolong the lifetime of the implanted artificial knee.
5. Before the stitches are removed, please avoid drinking alcohol or Chinese herbal medicines such as angelica and ginseng. You can take a bath three days after the stitches are removed from the wound. When entering and leaving the bathroom, you must be careful to slow down to avoid slipping and injury again.
6. Please inform the doctor that you have undergone the surgery if you unfortunately get injured or have to make teeth extracted. Antibiotics are necessary to prevent knee infection.
7. Please go to see the doctor according to the doctor’s prescriptions.
8. Please keep the surgical wound dry. If the following conditions happen, You should also go to see the doctor:
   1. It becomes red, swell, hot and painful. 
   2. It gets injured after falling.
   3. The range of motion decreases.

VI. Summarize：

Rehabilitation exercise can be started on the day after the operation, and assistive devices (walkers, crutches or wheelchairs) must be used when getting out of bed, and the assistive devices should be used for at least three months until the doctor tells them not to use them; 10-14 days after the operation during the return visit, the doctor will look at the condition of the wound and remove the stitches. Before the stitches are removed, please avoid eating Chinese herbal medicines such as angelica and ginseng to avoid bleeding from the wound. You can remove the dressing and take a shower 3 days after the stitches are removed to avoid take a bath and reduce the occurrence of infection.

VII.Reference：

1. 于博芮、胡文郁、胡月娟等(2021)‧肌肉骨骼系統疾病之護理‧於劉雪娥總校閱，成人內外科護理學下冊(八版，531-573頁)‧華杏。
2. 張瑞燕、吳佳蓉、李子晴、陳正豐、林麗華（2021）。復健運動對膝關節置換術病人的疼痛、關節功能與生活品質之成效探討。榮總護理，38(2)，120-132。https://doi.org/10.6142/VGHN.202106_38(2).0002
3. Bäcker, H. C., Wu, C. H., Schulz, M. R. G., Weber-Spickschen, T. S., Perka, C., & Hardt, S. (2021). App-based rehabilitation program after total knee arthroplasty: a randomized controlled trial. Archives of orthopaedic and trauma surgery, 141(9), 1575–1582. https://doi.org/10.1007/s00402-021-03789-0
4. Lindberg, M. F., Aamodt, A., Badawy, M., Bergvad, I. B., Borchgrevink, P., Furnes, O., Gay, C., Heir, S., Holm, I., Indrekvam, K., Kise, N., Lau, B., Magnussen, J., Nerhus, T. K., Rognsvåg, T., Rudsengen, D. E., Rustøen, T., Skou, S. T., Stubberud, J., Småstuen, M. S., … Lerdal, A. (2021). The effectiveness of exercise therapy and education plus cognitive behavioral therapy, alone or in combination with total knee arthroplasty in patients with knee osteoarthritis - study protocol for the MultiKnee trial. BMC musculoskeletal disorders, 22(1), 1054. https://doi.org/10.1186/s12891-021-04924-z