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 an enema to help empty your bowel.
5. The day before or on the day of surgery, bathing with soap or a body wash containing antibacterial agents can effectively reduce bacteria on the skin and lower the risk of postoperative wound infection.
6. Do not eat or drink for at least 8 hours before surgery. Please follow the instructions provided by your healthcare team.
7. On the day of surgery, an intravenous (IV) catheter will be inserted for the administration of fluids and medications.

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 . Pain medication may cause dizziness or postural hypotension. Change positions slowly and avoid bending over suddenly to reduce the risk of dizziness and falls.
3. On the first day after the operation, depending on the recovery situation, a nurse or physical therapist will assist you to use a walker to get out of bed; you should also raise the head of the bed when eating to avoid choking.
4. Place a pillow under the lower leg to elevate the operated leg and reduce swelling.(Figure 1) Do not place a pillow directly under the knee to avoid affecting blood circulation.(Figure 2).

   Figure 1（Correct）	Figure 2（Incorrect）

5. Please tell the nursing staff for assistance if you feel pain.
6. On the first day after surgery, the physical therapist 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 your condition and knee range of motion, the nursing staff will assist you with knee flexion exercises by using a continuous passive motion (CPM) machine (Figure 6). They will also teach you how to perform knee flexion exercises while sitting on the edge of the bed (Figure 7).
8. The nursing staff or physical therapist 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. Attend all scheduled follow-up appointments as instructed by your doctor.
8. Please keep the surgical wound dry. If the following conditions happen, You should also go to see the doctor:
   1. The surgical site becomes red, swollen, warm, or painful.  
   2. You fall and injure the operated knee.
   3. The range of motion of your knee 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 your doctor tells you that it is no longer needed; 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. Jia, Z., Zhang, Y., Zhang, W., Xu, C., & Liu, W. (2024). Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 19, 68. https://doi.org/10.1186/s13018-024-04536-y
2. Konnyu, K. J., Thoma, L. M., Cao, W., Aaron, R. K., Panagiotou, O. A., Bhuma, M. R., Adam, G. P., Balk, E. M., & Pinto, D. (2023). Rehabilitation for total knee arthroplasty: A systematic review. American Journal of Physical Medicine & Rehabilitation, 102(1), 19–33. https://doi.org/10.1097/PHM.0000000000002008
3. Zhou, W., Chu, S., Zhou, Y., & Huang, Y. (2024). Enhanced recovery after surgery for hip and knee arthroplasty: A systematic review and meta-analysis on randomized control trials. Geriatric Nursing, 60, 249–257. https://doi.org/10.1016/j.gerinurse.2024.08.002