Total knee replacement: indications, contraindications and postoperative rehabilitation

Author: Qu Tiebing, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Ren Dajiang, Chief Physician of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army

Artificial knee replacement, as the name suggests, refers to the partial or complete replacement of a damaged knee joint with an artificial joint through surgery to restore joint function, relieve pain and improve quality of life. However, not all patients with knee joint diseases are suitable for this surgery, and postoperative rehabilitation is also critical. Therefore, it is crucial for patients to have a comprehensive understanding of the knowledge related to the surgery.

When discussing the suitability of surgery, we must first clarify its contraindications and indications. Contraindications are divided into absolute contraindications and relative contraindications. An absolute contraindication refers to a situation where the doctor judges that the surgery will endanger the patient's life or cause serious complications, such as hemophilia, hemangioma around the knee joint, etc. In these cases, surgery must never be performed. A relative contraindication means that although the surgery can be performed, there are certain risks that need to be overcome through certain measures. For example, for patients with ankylosing knee arthritis, although the knee deformity is severe, replacement surgery is generally not recommended because there is no pain and the knee is in a functional position.

The indications for surgery mainly include three aspects: severe knee joint disease leading to impaired function, severe knee joint deformity and severe knee joint pain. As long as one of the above is met, artificial knee replacement can be considered.

In order to ensure smooth operation and rapid recovery after surgery, preoperative preparation is an indispensable part. For patients who take anticoagulants such as aspirin for a long time, such as patients with coronary heart disease, they need to stop taking the medicine for one week before surgery to reduce the risk of bleeding and lumbar spinal canal bleeding during surgery. Similarly, patients with rheumatoid arthritis need to gradually reduce the use of hormones before surgery to avoid rebound after surgery.

In addition, regardless of age, patients need to undergo adaptive training before surgery, including learning how to defecate in bed, use a walker, practice squatting, etc. These trainings help patients quickly adapt to a new lifestyle after surgery and reduce the difficulties and inconveniences during the rehabilitation process.

Postoperative rehabilitation is the key to the success of artificial knee replacement. Patients should start activities as soon as possible after surgery, including straight leg raising, bending, stretching and other movements to prevent thrombosis and promote joint function recovery. Straight leg raising and bending and stretching exercises become core movements. Although it is difficult to complete the prescribed number of times in the early stage, continuous efforts to achieve the goal one week after surgery are crucial to recovery.

Figure 1 Original copyright image, no permission to reprint

At the same time, patients should walk as soon as possible to reduce the risk of complications caused by bed rest. Usually, patients can walk 1-2 days after knee resurfacing surgery. During the rehabilitation process, the use of auxiliary devices such as walkers is also essential, but crutches should be avoided to prevent excessive dependence from affecting the recovery of leg strength. During the rehabilitation process, psychological factors cannot be ignored, and a positive attitude and family support are important driving forces for rapid recovery.

Figure 2 Original copyright image, no permission to reprint

Patients should gradually increase their activity under the guidance of a doctor. Usually, they can resume daily activities within one month after surgery, go up and down stairs within three months, and do light squats after six months. However, in order to extend the service life of the joints, excessive load should be avoided.

In terms of long-term maintenance, patients should follow the doctor's advice for regular checkups to monitor joint usage and prevent complications. Generally speaking, one month, three months, six months, and one year after surgery are key time points for follow-up. In addition, patients should also pay attention to maintaining good living habits and proper exercise to extend the service life of the artificial joint.

It is worth noting that the service life of artificial knee joints is affected by many factors, including the doctor's technical level, the patient's local conditions, and the wear resistance of the joint material. Therefore, when choosing a surgical hospital and doctor, patients should consider carefully and fully understand the relevant information.