美国AAOS关于-膝关节置换-医患须知

             Total Knee Replacement

                                     全膝关节置换广东省中医院骨科许树柴

         广州中医药大学附属广东省中医院二沙岛医院骨科     许树柴  李晓武   翻译并整理

       If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

    如果你的膝关节因为关节炎或受伤而严重破坏，可能让你很难进行简单的活动，如走路或爬楼梯。你甚至开始感到疼痛即便你是坐着或躺着。

If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

    如果像药物和使用助行支架等非手术治疗不能缓解症状，你可能要考虑行全膝关节置换手术。关节置换手术是一种安全有效的方法，能缓解疼痛，矫正畸形腿，并帮助你恢复正常活动。

Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.

    早在1968年，全膝关节就已经开展。此后，手术材料和技术的改进都大大增加了手术的有效性。全膝关节置换是医学界最成功的手术之一。根据美国医疗保健研究与质量局，在美国，每年有超过60万台膝关节置换手术。

    Whether you have just begun exploring treatment options or have already decided to have total knee replacement surgery, this article will help you understand more about this valuable procedure.

   无论你是刚刚开始探索治疗方案或已经决定要行全膝关节置换术，这篇文章将帮助您了解更多关于这个手术的过程。

Anatomy 解剖

  The knee is the largest joint in the body and having healthy knees is required to perform most everyday activities.

  膝关节是人体最大的关节，健康的膝关节对于我们大多数的日常活动是必须的。

The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily.

  膝关节由股骨下端、胫骨的上端、还有髌骨组成。这三块骨头，他们彼此的接触面均覆盖着光滑的关节软骨，这样保护骨骼，并使骨头之间能够轻松移动。

The menisci are located between the femur and tibia. These C-shaped wedges act as "shock absorbers" that cushion the joint.

  半月板位于股骨和胫骨之间。C形的半月板可以充当“减震器”以缓冲关节受力。

Large ligaments hold the femur and tibia together and provide stability. The long thigh muscles give the knee strength.

  大的韧带连接股骨和胫骨并提供稳定性。大腿肌肉为膝关节提供力量。

All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee.

  膝关节的关节面覆盖有薄的、被称为滑膜的组织。在健康的膝关节，这种滑膜能分泌一些液体，可以润滑软骨，使关节摩擦力几乎为零。

Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

   通常情况下，各个组织的协调工作。但疾病或外伤可破坏这种关节，可导致疼痛、肌肉无力，并减少关节功能。

Cause 病因

 The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoa  rthritis, rheumatoid arthritis, and post-traumatic arthritis.

     慢性膝关节疼痛和功能障碍的最常见原因是关节炎。虽然有许多类型的关节炎，膝关节疼痛往往是由于骨关节炎、类风湿性关节炎和创伤后关节炎这三种类型造成的。

· Osteoarthritis.This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

·  骨关节炎，这是一种与年龄有关的“磨损”类型的关节炎。通常发生在50岁及以上的患者，但也可发生于年轻人。缓冲关节受力的软骨软化和磨损。骨头相互摩擦，造成膝盖疼痛和僵硬。

· Rheumatoid arthritis.This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed "inflammatory arthritis."

· 类风湿关节炎，这是一种围绕关节的滑膜发炎和增厚的疾病。这种慢性炎症可破坏软骨，并最终导致软骨丧失，关节疼痛和僵硬。类风湿性关节炎是“炎性关节炎”最常见的形式。

· Post-traumatic arthritis.This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

· 创伤后关节炎，这可以发生在严重的膝关节损伤后。发生于膝关节的骨折、韧带损伤可以随着时间的推移，慢慢破坏关节软骨。导致膝关节疼痛、活动受限。

   Description  概述

   A knee replacement (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones are actually replaced

  膝关节置换术，更准确地说应该是膝关节表面的置换，因为置换的只是骨头的表面。

There are four basic steps to a knee replacement procedure.

     膝关节置换术有四个基本步骤。

· Prepare the bone.The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.

· 骨准备。去除股骨和胫骨最表层的已损坏的软骨。

· Position the metal implants.The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or "press-fit" into the bone.

· 植入金属假体。金属假体替换被去除的软骨和骨，重新组成关节的接触面。这些金属部件可以粘住或被打入骨头。

· Resurface the patella.The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.

· 修复髌骨。修剪并用用塑料扣修复髌骨的底面。一些医生在一些情况下不修复髌骨。

· Insert a spacer.A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

· 插入垫片。在金属部件之间插来塑料垫片，创建一个更顺滑的表面。

      Is Total Knee Replacement for You?    全膝置换术适应证

   The decision to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopaedic surgeon. Your physician may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.

   是否行全膝关节置换术应该是由你、你的家人、你的家庭医生、和你的骨科医生共同决定的。医生可能会对你的身体进行彻底的评估，以确定你是否适合行该手术。

   When Surgery Is Recommended     什么时候会建议行置换术？

There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:

  医生建议行膝关节置换术是有原因的，适合行置换术的人通常有以下问题：· Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker

· Moderate or severe knee pain while resting, either day or night

· Chronic knee inflammation and swelling that does not improve with rest or medications

· Knee deformity — a bowing in or out of your knee

· Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

· 严重的膝关节疼痛或僵硬，限制你的日常活动，包括散步，爬楼梯，连坐椅子都受影响。你可能会觉得没有显著的疼痛也走不了多远，并且可能需要使用拐杖或助行器

· •无论是白天还是夜晚休息时均可感到 中度或重度膝关节疼痛

· •慢性膝关节炎症和肿胀，休息或药物均不能改善

· •膝关节畸形 - 内翻和外翻等

· •其他治疗，如消炎药，激素，润滑注射，物理疗法，或其他手术不能显着改善症状

Candidates for Surgery

手术适应的人群

There are no absolute age or weight restrictions for total knee replacement surgery.

   全膝关节置换手术没有绝对的年龄或体重限制。

Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

   手术是根据病人的痛苦和功能障碍的情况而定的，而不是年龄。接受全膝关节置换术的患者大多是50岁至80岁，但骨科医生的评估因人而异。全膝关节置换已成功在所有年龄段完成，从患少年关节炎的年轻的少年到患退行性关节炎的老年患者。

     Orthopaedic Evaluation   专科评估

   An evaluation with an orthopaedic surgeon consists of several components:

   骨科医生的手术评估包括：

· A medical history.Your orthopaedic surgeon will gather information about your general health and ask you about the extent of your knee pain and your ability to function.

· A physical examination.This will assess knee motion, stability, strength, and overall leg alignment.

· X-rays.These images help to determine the extent of damage and deformity in your knee.

· Other tests.Occasionally blood tests, or advanced imaging such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your knee.

· 病史：医生将收集有关你的健康信息，并评估你的膝盖疼痛和功能障碍的程度。

· 查体：这将评估膝关节的运动功能，稳定性，强度，和下肢力线等。

· X射线：有助于确定你膝盖损伤和畸形的程度。

· 可能需要的其他测试。有时候验血或先进的成像，如磁共振成像（MRI）扫描，可以用以确定膝盖的骨和软组织的状况。

Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement is the best method to relieve your pain and improve your function. Other treatment options — including medications, injections, physical therapy, or other types of surgery — will also be considered and discussed.

  医生将根据你的检查结果，讨论全膝关节置换是否是减轻你疼痛，改善你膝关节功能的最佳方法。其他的治疗方案 - 包括药物，注射，物理疗法，或其他类型的手术 - 也将被考虑和讨论。

   In addition, your orthopaedic surgeon will explain the potential risks and complications of total knee replacement, including those related to the surgery itself and those that can occur over time after your surgery.

此外，医生会解释全膝关节置换术潜在风险，包括与手术本身有关和可以发生在手术后的并发症。

Deciding to Have Knee Replacement Surgery  决定行全膝关节置换术

       Realistic Expectations    手术期望

 An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and cannot do.

    决定是否要行全膝关节置换手术的一个重要因素是要了解这个手术能给我们带来什么，不能带来什么。

More than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you could before you developed arthritis.

    超过90％的行全膝关节置换手术的患者可以急剧减少膝关节疼痛并明显改善日常生活能力。但全膝关节置换不能使你的状况比在患关节炎前更好。

With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports for the rest of your life after surgery.

  在正常使用和活动下，每个膝关节假体开始在其塑料垫片磨损。过度活动或重量过重可能加快这一过程，并可能导致膝关节假体松动，产生痛苦。所以，大多数骨科医生建议在你术后恢复的过程中，避免高强度的活动，如跑步，慢跑，跳跃，或其他高冲击力的运动。

Realistic activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports.

    全膝关节置换术后可以进行的活动包括散步，游泳，高尔夫，驾驶，轻远足，骑自行车，交谊舞等低强度运动。

With appropriate activity modification, knee replacements can last for many years.

    适当的活动可以使膝关节假体寿命维持很多年。

       Possible Complications of Surgery        手术可能的并发症

  The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.

    全膝关节置换术的并发症的发生率低。严重的并发症，诸如膝关节感染，发生率少于2％。其他主要的并发症，如心脏病发作或中风的发生就更低。慢性疾病可能会增加并发症的发生率。这种情况虽然少见，但当这些并发症发生，可以延长或限制你的恢复。

Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

在手术前充分与你的医生讨论你的问题。

Infection. Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

   感染：感染可发生在伤口或假体周围，可以发生在医院或出院回家后。甚至可能发生在术后若干年。在伤口表面轻微的感染通常用抗生素治疗。重要的或深部感染，可能需要更进一步的手术和去除假体。任何在你身体的感染均能扩散到你置换的关节。

Blood clots. Blood clots in the leg veins are the most common complication of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.

    血栓形成：膝关节置换手术最常见的并发症是下肢静脉栓塞。如果血栓脱落到达肺部，可危及生命。医生将制定一个预防方案，其中可能包括定期抬高你的腿，小腿练习以增加血液循环，弹力袜和用药物来预防血栓形成。

 Implant problems. Although implant designs and materials, as well as surgical techniques, continue to advance, implant surfaces may wear down and the components may loosen. Additionally, although an average of 115° of motion is generally anticipated after surgery, scarring of the knee can occasionally occur, and motion may be more limited, particularly in patients with limited motion before surgery.

  假体问题。尽管假体的设计和材料，以及外科手术的技术发展很快，假体的表面可能会磨损和松动。此外，尽管术后膝关节的平均活动度可达到115°，由膝关节上的疤痕，可能导致膝关节活动受限，尤其是在术前就有活动受限的患者。

Continued pain. A small number of patients continue to have pain after a knee replacement. This complication is rare, however, and the vast majority of patients experience excellent pain relief following knee replacement.

   持续的疼痛。少数患者在术后有持续的疼痛。这种并发症是罕见的，绝大多数患者可以体验到膝关节置换带来的明显的疼痛减轻。

Neurovascular injury. While rare, injury to the nerves or blood vessels around the knee can occur during surgery.

神经血管损伤。膝关节周围神经或血管损伤罕见，可发生在手术过程中。

              Preparing for Surgery    手术准备

                 Medical Evaluation    医学评估

      If you decide to have total knee replacement surgery, your orthopaedic surgeon may ask you to schedule a complete physical examination with your family physician several weeks before the operation. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such as a cardiologist, before the surgery.

      如果你决定要全膝关节置换手术，骨科可能会要求你在手术前几个星期接受你的家庭医生一次完整的身体检查。这对于确保你身体可以接受手术和完成恢复过程的相当必要的。一些有慢性疾病，如心脏病的患者在术前需要专家对身体进行评估。

           Tests  检查

Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help your orthopaedic surgeon plan your surgery.

一些检查，在骨科医生进行手术前需要进行，如血液和尿液的检测以及心电图等。

              Medications  药物

Tell your orthopaedic surgeon about the medications you are taking. He or she will tell you which medications you should stop taking and which you should continue to take before surgery.

告诉你的骨科医生你正在服用的药物，医生会告诉你，在手术前，哪些你应该停止服用，哪些可以继续服用。

             Dental Evaluation  牙科评估

  Although the incidence of infection after knee replacement is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your total knee replacement surgery.

虽然膝关节置换术后感染不常见，如果细菌进入你的血液，感染就可能发生。主要的牙科手术（如拔牙和牙周工作）应在你的膝关节置换手术前完成。

       Urinary Evaluations   泌尿系评估

 People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before undertaking knee replacement surgery.

最近或经常有尿路感染的病史的患者在手术前应该有一个泌尿评价。有前列腺疾病的老年男性应在手术治疗前应完成必要的治疗。

      Social Planning    社会生活计划

Although you will be able to walk on crutches or a walker soon after surgery, you will need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry.

虽然你可以在手术后不久靠拐杖或助行器走路，你还是需要几个星期的帮助，例如烹饪，购物，洗澡，洗衣等。

If you live alone, your orthopaedic surgeon's office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at home. They also can help you arrange for a short stay in an extended care facility during your recovery, if this option works best for you.

如果你独自生活，你的骨科医生办公室、社会工作者或者医院的出院处可以帮助你在家的时候得到他人的帮助。也可以根据你的需要在你术后的恢复过程把你暂时安排在一个有充分护理设施的地方。

       Home Planning  家庭计划

Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

一些改动可以让你的家在你的恢复过程中更轻松地进行导航。下列项目可以帮助你的日常活动：

· Safety bars or a secure handrail in your shower or bath

· 在你淋浴器或浴缸安装牢固的安全扶手或扶手

· Secure handrails along your stairways

· 所有楼梯都安装安全扶手

· A stable chair for your early recovery with a firm seat cushion (and a height of 18 to 20 inches), a firm back, two arms, and a footstool for intermittent leg elevation

· 你早期的康复需要一张有坚固的座垫的稳定的椅子（高度18到20寸），这张椅子要有一个坚定的靠背以及两个扶手，还要有一张凳子以便间歇地抬高腿。

· A toilet seat riser with arms, if you have a low toilet

· 如果你家厕所较低，可以安装一个扶手在马桶旁边

· A stable shower bench or chair for bathing

· 稳定的淋浴板凳或椅子洗澡

· Removing all loose carpets and cords

· 去除所有松动的地毯和线

· A temporary living space on the same floor because walking up or down stairs will be more difficult during your early recovery

· 在同一层楼有个临时的地方住，因为上下楼梯在你的早期康复期是特别困难的

      Your Surgery  手术

       Anesthesia   麻醉

After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

    入院后，你的麻醉团队成员将会对你进行评估。麻醉中最常见的类型是全身麻醉（你进入睡眠状态）或脊髓，硬膜外或区域神经阻滞麻醉（你是清醒的，但你的身体从腰部以下无感觉）。麻醉团队会根据你的具体情况决定麻醉的哪种类型是最适合你的。

    Procedure  手术过程

  The procedure itself takes approximately 1 to 2 hours. Your orthopaedic surgeon will remove the damaged cartilage and bone, and then position the new metal and plastic implants to restore the alignment and function of your knee.

   该手术本身需要大约1到2小时。医生将取出损坏的软骨和骨，然后放置新的金属、塑料假体等来恢复你的膝盖的对齐方式和功能。After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room.

   手术后，你将被送到恢复室，你会在那呆几个小时直到你从麻醉中恢复。当你醒来时，你会被带到你的病房。

       Your Hospital Stay   住院期间

You will most likely stay in the hospital for several days.

     你很有可能要再医院住几天。

      Pain Management    疼痛控制

After surgery, you will feel some pain, but your surgeon and nurses will provide medication to make you feel as comfortable as possible. Pain management is an important part of your recovery. Walking and knee movement will begin soon after surgery, and when you feel less pain, you can start moving sooner and get your strength back more quickly. Talk with your surgeon if postoperative pain becomes a problem.

手术后，你会感到有些疼痛，但你的医生和护士会提供药物让你感到尽可能舒适。疼痛控制是你恢复过程的一个重要组成部分。术后很快就可以开始活动关节，当你感到疼痛少的时候，你就可以开始活动得更快，并快速地恢复你的力量。如果术后疼痛难忍请与你的医生交谈。

      Blood Clot Prevention    预防血栓

    医生可能会使用多种措施以防止血栓形成，减少腿部肿胀。包括特殊的支持袜子，可充气的腿覆盖物（压缩靴），以及抗凝药。

鼓励术后可立即进行足部和踝关节运动，以促进你腿部肌肉的血液循环，以帮助防止腿部肿胀和血栓形成。

       Physical Therapy    物理治疗

  大多数患者在术后第二天就开始运动他们的膝关节。理疗师会教你具体的练习方法以促进你的腿和膝关节恢复运动，使你在术后不久可以开始步行和其他日常活动。

  为了恢复在你膝关节和腿部的活动，医生可能会使用一个膝关节支撑装置，慢慢地在床上移动你的膝关节。该装置被称为持续被动运动（CPM）运动机，通过抬高你的腿部预防肿胀，并通过活动你腿的肌肉改善血液循环。

          Preventing Pneumonia   预防肺炎
     术后早期的病人常会出现呼吸浅弱。这通常是由于麻醉、止痛药物、卧床时间增长的影响。这个浅弱呼吸可导致肺的部分塌陷（称为“肺不张”），它可以使患者易患肺炎。为了防止出现这种情况，经常深呼吸是很重要的措施。护士可以提供一个叫肺活量计的简单的呼吸装置来帮助你深呼吸。

         Your Recovery at Home   家庭康复过程

      你的手术成功与否在很大程度上取决于你在术后回家的最初几周是否按照医生的指示执行。

              Wound Care   伤口护理

       可能会有针或钉在你的膝关节前面的伤口或皮肤下缝合。术后几周后即可拆除。皮下的缝合不需要拆除。

      避免让伤口湿润，直到它完全密封和干燥。您可以继续包扎伤口，以防止来自衣服或袜的刺激。

                Diet    饮食

     手术后的几个星期食欲减退是很常见。均衡的饮食，且经常有补铁，对于促进相应的组织愈合，恢复肌肉力量是很重要的。

            Activity    活动锻炼

     运动是家庭康复的重要组成部分，特别是在手术后的最初几个星期。在术后的3到6个星期内，你应该能够恢复最基本的日常活动。术后几个星期内晚上活动时疼痛是很常见的。

   你的锻炼计划包括：

      一个适当的活动计划可以慢慢地增加你身体的流动性，最初是在家，慢慢地延伸到户外。

· 恢复正常的家庭活动，如坐，站立，和爬楼梯

· 一天几次具体的锻炼以恢复运动和加强你的膝关节。你可能会在没有帮助的情况下完成练习，但你也可以在术后前几周有物理治疗师在家或在治疗中心帮你

你很可能能够恢复驾驶，当你的膝关节活动度尚可，可以让你进入并舒适地坐在车上，当你的肌肉恢复使你能有足够的反应时间，制动和加速。大多数人可以在术后4到6周恢复驾驶。

             Avoiding Problems After Surgery   预防术后问题

             Blood Clot Prevention   预防血栓形成

  仔细按照医生的指示做，以减少在恢复的最初几个星期内血栓发展的风险。医生可能会建议您继续服用在医院就开始服用的抗凝药。如果您发现以下任何征兆请立即通知你的医生。

  警惕血栓形成的预兆，下肢血栓形成的预兆包括：

 小腿疼痛加重

 膝关节周围出现压痛或局部发红

 小腿、踝部及足部出现进行性疼痛

  警惕肺栓塞形成的预兆，血栓脱落入肺的征兆包括：

 突然出现呼吸急促

 胸痛突然发作

 出现咳嗽导致的胸痛

Preventing Infection   预防感染

A common cause of infection following total knee replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your knee replacement and cause an infection.

  导致膝关节置换手术感染的常见因素是：在牙科手术，泌尿道感染或皮肤感染时细菌进入血液。这些细菌可以集聚在置换的关节周围导致感染。

After your knee replacement, you must take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream.

      膝关节置换手术后，你必须在可能让细菌进入血液的牙科或其他外科手术前使用预防性抗生素。

Warning signs of infection. Notify your doctor immediately if you develop any of the following signs of a possible knee replacement infection:

    出现感染的征兆。如果您发现以下任何一个可能的膝关节置换感染的迹象请立即通知你的医生：

· Persistent fever (higher than 100°F orally)  · 持续发热（高于37.7℃）

· Shaking chills

· 寒战

· Increasing redness, tenderness, or swelling of the knee wound

· 膝关节伤口呈进行性发红，压痛或肿胀

· Drainage from the knee wound

· 伤口出现渗液

· Increasing knee pain with both activity and rest

· 活动和休息时均出现进行性疼痛

             Avoiding Falls    预防跌倒

   在手术后的最初的几个星期跌倒可能会损害你的新膝关节，并可能会导致需要进行更多的手术。在你的膝关节有足够强度和活动度之前，爬楼梯是特别危险的。你应该使用拐杖，助行器，或扶手或有人扶你，直到你提高你的平衡性、柔韧性和力量。

你的骨科医生和理疗师会帮你选一些手术后可以帮助你的工具，并告诉你何时可以安全地停止使用这些工具。

             Outcomes   术后情况及结果

How Your New Knee Is Different

       新关节会带来一些不适应

      膝关节活动改善是全膝关节置换术的目标，但全部恢复是罕见的。术后膝关节的活动可以根据术前膝关节活动度来预测。大多数患者术后几乎可以完全伸直膝关节，并且可以充分屈曲膝关节以上下楼梯和进出车。有时候下跪是不舒服的，但是无害的。

       大多数人会觉得切口周围的皮肤麻木。也可能会感到关节僵硬，特别是过度屈曲膝关节的时候。

      大多数人在屈曲膝关节或走路时可以感觉到或听到金属和塑料假体的响声。这是正常的现象并且往往会随着时间的推移而减少，大多数患者觉得他们的疼痛和活动受限的情况予术前相比有所改善。

    你的新膝关节在机场和一些建筑物的安检时会引起金属探测器报警。如果报警被激活，告诉安检员你曾行膝关节置换术。

         Protecting Your Knee Replacement     保护你的新关节

    术后确保你要做到以下几点：

· 采取特殊的预防措施，以避免摔倒和受伤。如果你的腿骨折了，你可能需要更进一步的手术。

· 确保您的牙医知道你刚行膝关节置换术。在任何牙科手术前你均需要使用抗生素。

· 定期骨科复诊并进行常规随访检查和X光片，一年复查一次。

        Extending the Life of Your Knee Implant      延长假体的寿命

     目前，超过90%的现代全膝关节置换假体在术后15年仍然运作良好。术后按照医生的指示，注意保护你的新膝关节并保持身体健康，是你手术成功的重要因素。