EA010788B1 - Method for rehabilitation of patients after total hip and knee arthroplasty - Google Patents

Abstract

The invention relates to medicine, in particular, to curative and rehabilitation exercises after hip and knee arthroplasty for use in medical institutions, sanatoria and health resorts facilities, as well as domestically for patient rehabilitation. A rehabilitation program is worked out comprising curative exercises aimed at restoration of locomotive activities in hip and knee joints using multi-step principle, in 6 steps broken down according to time periods, rules of patient behavior in earlier postoperative period and rules of patient behavior in daily routine life in long-term postoperative period.A complex of curative gymnastics comprises curative, respiratory and relax exercises.The method is aimed at the most effective restoration of the locomotive activities of the hip and knee joints, minimizing a complication risks, encouraging restoration of hip support ability, strengthening the lower extremities muscle system, stimulating trophism, increasing movement amplitude in the operated joint, relieving patient pain, increasing prosthesis life time in bone tissue, returning the patient to active life.

Description

The invention relates to medicine, namely to medical rehabilitation gymnastics for patients after hip and knee replacement, and can be used in medical institutions, in sanatorium-resort, as well as at home for the rehabilitation of patients.

One of the indications for hip and knee arthroplasty is coxarthrosis and aseptic necrosis of the femoral head, gonarthrosis. Coxarthrosis of the hip joints is one of the most frequent and severe forms of degenerative joint diseases. The development of coxarthrosis is influenced by numerous and various abnormalities in the development of the bones of the pelvis, spine and lower extremities: a decrease in the acetabulum, congenital dislocations and subluxations, scoliosis of the spine, asymmetric growth, different lengths of the lower extremities. The disease develops on the basis of Perthes disease, lesions of one limb with polymyelitis, a fracture of the femoral neck, trauma to the femoral head. Secondary coxarthrosis often affects both joints differently or are unilateral. Primary ones are usually symmetrical.

Unlike other localizations of arthrosis in coxarthrosis, there is a clear correlation between clinical symptoms and radiological changes. Moreover, sometimes even clinical symptoms appear in the first place. Pain during walking and lameness at first appears only towards the end of the working day, later it lasts all day, and in severe cases it is so intense that it prevents the patient from falling asleep, radiating to the knee joint, to the sciatic and inguinal regions.

Gait becomes sparing. Due to the violation of static or shortening of the limb, lameness appears. Often, with small radiological changes in the joint, its function is impaired, which is probably associated with damage to the joint bag and a reduction in regional muscles. In the early stage of the process, first of all, abduction and internal rotation are limited, in the late stage - all types of movement in the hip joint. (Encyclopedia of traditional and alternative medicine). Aseptic necrosis of the femoral head in adults (ANGB) is a serious disease of dystrophic genesis, leading to persistent disability. The essence of the disease lies in the subchondral necrosis of part of the bone substance of the femoral head with its subsequent destruction in the most loaded segment with the outcome in coxarthrosis.

ANGBC is not such a rare disease, according to various authors, it accounts for 1.2 to 4.7% of the entire orthopedic pathology of the hip joint.

It has been established that significant disturbances in venous blood flow are detected in patients already at the very early stages of the disease, when there are still no radiographic signs, and accompany the course of an angioplasty during the entire period of the disease.

The dynamics of venous blood flow disturbances echoes with the stages of the disease of an angioplasty and determines the choice of treatment methods.

According to our data, effective conservative treatment is possible only at the first stage of the disease. At stage II of ANGBC, tunneling of the head and neck of the femur, intertrochanteric osteotomy are effective. At stages III and IV of the disease, the operation of choice is endoprosthetics. (I.M. Mitbraith, G.N. Golubenko “Aseptic necrosis of the femoral head in adults (etiology, pathogenesis, choice of treatment method. 1Sp: // \ u \ u \ u.dkY3.gi / riy | casp / 1ga \ utaUloschs | / a5erNe5k |) / tbeh.k1it1). Gonarthrosis of the knee joint often undergoes a degenerative lesion, which in 33% of cases is combined with a similar lesion of other joints or the spine. Gonarthrosis is approximately equally common in men and women, but severe forms are also observed in women at an earlier age. In the initial stage of the disease, patients note short-term minor pain in the joint that occurs when walking for a long time, after physical exertion, sometimes pain in the calf muscles and quadriceps femoris. Inflammation periodically occurs (swelling, increase in local temperature, palpation of soreness), which usually lasts 3-4, less often 10-15 days. In individual patients, depending on the nature of the lesion and working conditions, inflammatory changes in the joint (secondary synovitis) may recur every 2-3 months. This leads to the development of sclerotic changes in the synovial membrane, which affects the functional state of the synovial fluid, and therefore the cartilage tissue. Fibrous changes in the periarticular tissues gradually occur. In the last stage of the process, individual fragments of gross osteophytes can come off and be in a free state in the joint cavity. Getting into the joint space, these formations cause sharp pains, and the patient is deprived of the ability to move.

Positive pain in the affected joint recurs secondary synovitis, displacement of the axis of the limb, restriction of active and passive movement in the joints lead to hypotrophy of the regional muscles, which, along with thickening of the periarticular tissues, displacement of the patella contributes to joint deformation. More pronounced violations of these parameters of muscle function are observed with recurrent secondary synovitis, in a later stage of the disease. The patient’s gait becomes more gentle, as sharp movements in the joints, wide steps cause sprains and capsules, in which pain occurs.

The main clinical and biomechanical signs of damage to the musculo-ligamentous apparatus of the knee joint with gonarthrosis are:

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1) pain in the anterior lower third of the thigh;

2) fatigue of the lower extremities;

3) the appearance of instability in the knee joints;

4) the development of lateral deformities of the knee joints;

5) displacement of the patella;

6) hypotrophy of the thigh muscles;

7) a decrease in the volume of active and passive movements in the knee joint;

8) decreased muscle strength of the thigh;

9) lengthening the period of contraction of the quadriceps femoris;

10) a decrease in the elasticity (tone) of the thigh muscles;

11) a decrease in the bioelectric activity of muscles on EMG;

12) hypermobility of the knee joints.

Radiographs of the knee joints in the early stage of gonarthrosis may indicate cystic restructuring of the bone structure, linear osteosclerosis in the subchondral part, the appearance of small marginal osteophytes. These radiological changes correspond to the first stage. In the second stage, in addition to them, there is a more pronounced osteosclerosis and a narrowing of the joint space. Gonarthrosis of the third stage is characterized by severe subchondral osteosclerosis, large marginal osteophytes, a significant narrowing of the joint space. In the fourth stage, coarse, massive osteophytes are revealed, the joint gap is difficult to trace, the pineal glands of the bones that form the joint are deformed.

When diagnosing gonarthrosis in the early stage, if there are no radiological signs of bone tissue damage, it is very important to determine the nature of the inflammatory process in the joint (synovitis). In this regard, the scintigraphic method of radionuclide research is of particular importance, with which, at the initial stage of arthrosis, small-focal and medium-focal synovitis is detected, which is localized in the region of the upper and lower patella inversion. Clinically reactive synovitis is determined in 1/2 patients with gonarthrosis, while the radiological method allowed to detect it in 2/3 of patients of the first, second stage and in all patients in the third stage of arthrosis.

An increase in local temperature with arthrosis is rarely determined. In order to identify latent reactive synovitis of the knee joint, a thermal imaging method is used.

In some patients with gonarthrosis, synovitis can become persistent, which makes diagnosis difficult. During the development of synovitis, a moderate number of cellular elements (3000-5000 in 1 mm) are morphologically revealed in the synovial fluid; neutrophils make up 25-30%.

In biopsy samples of cartilage tissue are found:

1) a decrease in the area of perichondrocytic gaps in the surface layers;

2) a decrease in cell density in the deep layers;

3) a decrease in the number of nuclei in the gaps of the middle layer;

4) an increase in the thickness of the calcified layer of cartilage.

In a general clinical blood test, a mild or moderate increase in ESR is detected in 40% of patients with arthrosis. The blood formula, as a rule, does not change.

Polyarthrosis is a degenerative disease of many joints at the same time. This is usually the primary form of the disease. It usually develops in old or senile age under the influence of endocrine-metabolic, climacteric disorders, toxic effects and other causes. It occurs at a young age. Polyarthrosis is characterized by a combination of lesions of the joints of the limbs and spine. Moreover, Heberden's nodules are almost always observed. (Encyclopedia of traditional and alternative medicine. Yyr: //te^et.u11at1po.pe1/gi8-27600-676661586ag111go515-6823.111t1).

There is a method for the rehabilitation of patients after hip replacement using a complex of therapeutic exercises (Questions of balneology and physiotherapy No. 4, 2002, p. 37, V.P. Lapshin, E.A. Chukina, I.Yu. Klyukvin, V.V. Antonov , K. S. Larionov, Yu.A. Bogolyubsky. "Therapeutic gymnastics in the rehabilitation treatment of elderly and senile patients after hip replacement," M., N.V. Sklifosovsky Research Institute of Compression).

This method of rehabilitation is taken by the authors as an analogue.

In the first three days of the postoperative period, isometric muscle tension of the damaged limb is performed. From the 4th-5th day after the operation, long-term isometric muscle tension was included in the therapeutic gymnastics complex, gradually increasing their duration to 5-7 seconds with 810 repetitions by each muscle group. Passive movements in the hip joint are not used because of the danger of dislocation of the endoprosthesis head at the initial stage of treatment. The methodology of therapeutic gymnastics provides for independent exercise (2-4 times during the day). During the first 3 days after surgery, patients are only allowed to sit in bed and turn to their healthy side. On the 3-5th day, patients sit in bed, legs dangling. On the 7-10th day, patients are transferred to an upright position and taught to walk with the help of crutches or “walkers”. With unipolar, as well as with subtotal endoprosthetics with bipolar endoprostheses with cement fix

- 010788 by using the femoral component, patients walk with a full load on their injured leg 3 weeks after the operation. In case of total cement arthroplasty, patients walk, fully loading the operated leg, 1.5 months after the operation.

This method does not use the performance of passive exercises in the early postoperative period, except for isometric muscle tension of the damaged limb, thereby slowing down the process of effective restoration of muscle tone of the lower extremities, flexion and extensor functions of the operated joint. At the same time, the method delays the activation of the patient in the early postoperative period, the vertical position of the patient for 7-10 days after surgery, which increases the risk of postoperative complications associated with the blood circulation in the operated limb, and also slows down the stabilization of the patient's psychoemotional state. A significant drawback of the method is the early refusal of support and the transition to walking with a full load on the operated joint after 3 weeks. These recommendations of the method can lead to postoperative complications, dislocation of the head of the endoprosthesis, instability of any components of the endoprosthesis in the bone tissue and reoperation, since complete restoration of the operated limb occurs after 3-4 months (N.V. Zagorodni, S.A. Kalashnikov, X .M. Magomedov. “Low-friction endoprostheses in the surgery of the hip joint.” Vestnik, RUDN University, series “Medicine”, 2002, No. 2, p. 56).

The issue of rehabilitation of patients after hip and knee arthroplasty is a poorly studied area. Currently, there are no satisfactory ways to rehabilitate such patients.

A known method of rehabilitation of patients with hip replacement by performing exercises on simulators of narrow-local action (RF Patent No. 2309721, IPC A61H 1/00, 2006.01).

The above method was taken as a prototype.

In accordance with the specified method, the rehabilitation program for patients before and after the operation takes place on simulators of narrow-local action. This program includes performing exercises on many simulators, one of them is the MTB-тренаж simulator, where the patient, kneeling between the stands, hands is fixed on the straps, trying to achieve maximum stretching of the lateral parts of the body by touching the floor along the frontal plane.

In the same program, it is proposed to perform exercises on simulators No. 19 and MTB-Ι. Exercises on the simulator No. 19 are performed with increasing weight weights, and the weight increases from session to session. However, the clear boundaries of the weights are not indicated, the patient's age, his diagnosis, body weight, and concomitant diseases are not taken into account. On the MTB-тренаж simulator, it is proposed to perform the exercise "Frog" and the exercise "Twisting". The method suggests that from 2-6 days after surgery daily for 2 weeks to perform exercises on narrow-local simulators with a gradual increase in weights.

The author of the method gives an example of its implementation, in which the patient after 2-3 months cancels the use of crutches, after 4 weeks the patient walks with a cane with full support on the operated limb, after 8 weeks he walks without additional support. In the distant postoperative period, the author of the method recommends practicing sports such as skiing, tennis, guided by personal feelings and good health.

A significant drawback of performing exercises on the MTB-тренаж simulator before surgery is the appearance of severe pain with bilateral damage to the hip joints, the performance of the same exercises after surgery and the early refusal to use crutches with full axial load and reliance on the operated limb, trauma-hazardous sports, in which jerky movements, jumps, running are inevitable, where the state of the endoprosthesis is monitored with the help of its sensations, and not with x-ray studies, can lead to sti to postoperative complications, to dislocation of the head of the endoprosthesis and reoperation for the revision of the endoprosthesis. (N.V. Zagorodni, S.A. Kalashnikov, Kh.M. Magomedov. “Low-friction endoprostheses in hip joint surgery.” Vestnik, RUDN, Medicine series, 2002, No. 2, p. 56).

The same complications associated with the repeated operation can arise from performing exercises on the MTB-тренаж Frog, Twisting simulator, in which all movements are associated with rotation, twisting, abduction, and bringing the foot inward. From the use of any simulators of narrow-local action, from 2-6 days after the operation, even with the use of thin dosages, there is a possibility of secondary bleeding from 1 to 2 liters of blood loss (Kustov V.M., Kornilov N.V., 2004; Vitalnye Ν., 1996; Nap., 1997; 1acobzop M., 2004). However, there are difficulties with the use of simulators associated with the need to bandage the legs with elastic bandages (from 2-4 days to 2 months) to prevent thromboembolism. Exercise on narrow-local simulators for elderly people with a history of history, concomitant cardiovascular diseases, severe somatic pathologies, as well as patients suffering from systemic diseases such as rheumatoid arthritis, systemic lupus erythematosus, can lead to a negative impact on the human body. Ankylosing spondylitis. In some cases, such patients suffer from postoperative exacerbations of systemic diseases that do not stop within

- 3 010788 several days.

Difficulties with the use of simulators in the postoperative period can arise from neurological disorders present as a result of dystrophic changes in the segmental and central apparatus of the autonomic nervous system due to sympathicotonia.

To avoid such complications, these disorders are prevented, which is expressed in the form of unstable blood pressure, increased heart rate, headaches, sleep disturbance, labile psyche, etc., disappearing 2-4 weeks after the use of appropriate therapy. (Certificate for an intellectual product. A method for the correction of circulatory and autonomic disorders in the early postoperative period with hip joint arthroplasty No. 73200600070 of 11/27/2006 auth. Shchekolova NB).

The author of the method believes that most existing methods for the rehabilitation of joints after endoprosthetics prohibit various movements in the operated limb for 3-6 months after surgery, but do not confirm this information with existing recovery methods.

According to the author, not a single clinic in Russia has such an arsenal of simulators, which require the involvement of specially trained personnel to work on them.

The rehabilitation method for narrow-local simulators is suitable only for a limited age category of patients who do not have concomitant diseases.

The proposed method of rehabilitation eliminates the above disadvantages, is cost-effective, is easily implemented in all medical clinics of Russia, does not require additional involvement of specialists, consists of a complex of therapeutic exercises, combining breathing and therapeutic exercises performed simultaneously.

When creating the invention, the problem was solved of the most effective restoration of the motor activity of the hip and knee joints after the endoprosthetics operation using the principles of multi-stage, systematic and regular implementation of therapeutic exercises that minimize the risk of complications associated with the instability of all components of the endoprosthesis (for example, legs, cups, etc.). n.), dislocation of the head of the endoprosthesis and subsequent reoperation (revision), contribute to the restoration of support ability of the thigh; strengthening the muscle system of the lower extremities and lumbar spine; stimulation of trophism and the fight against hypertrophy and atrophic phenomena in the muscles; improving blood supply and eliminating pain in the operated joint and spine; strengthening the thigh muscles in the operated joint of both the flexors and extensors; increase in the range of motion in the operated joint; normalization of the neuromuscular apparatus of the limb; rid the patient of pain, lameness, straight leg syndrome; movement without support; development and consolidation of the stereotype of movements in the joint; restoration of the stereotype of walking; adaptation to everyday life; increase the life of the endoprosthesis in the bone tissue; the patient’s return to an active lifestyle.

This task is achieved by the fact that in the proposed method of rehabilitation of patients after hip replacement, including performing therapeutic exercises, the complex of which contains combined breathing, therapeutic exercises and relaxation exercises, according to the invention, a rehabilitation program consisting of therapeutic exercises aimed at restoring motor activity in the hip and knee joints are performed using the principles of multi-stage, 6 stages, broken down by temporary prom creepy, subject to the conditions for performing a set of exercises, the patient’s rules of conduct in the early postoperative period and the patient’s rules of behavior in everyday life in the distant period.

At the same time, the exercise period begins from the first stage, which lasts 1-3 days after the operation, where the patient is put on his feet by the specialist for 3-10 seconds to prevent the formation of thrombophlebitis, and from the 3rd day under control they put on “ walkers ", then perform a series of facilitated passive and active exercises in the diseased and healthy limbs with the help of a specialist and under the supervision of a specialist, with a duration of 5-15 minutes.

Then, during the exercise of the second stage, which lasts 4-15 days after hip joint replacement, the patient performs passive, passively active, active exercises in lightened starting positions lying on his back, sitting with the help of a specialist, under his control, and from 8-10 days after surgery, the exercises are performed mainly in a liquid medium, while from 5-6 days the patient actively begins to walk on crutches, after knee replacement, the patient performs passive, passively active, active exercises I am in lightened starting positions lying on my back, lying on my stomach and healthy side, sitting, standing in a liquid medium, with the help of a specialist, under the supervision of a specialist, and from 7-8 days after the operation, active exercises are performed mainly in a liquid medium in sitting and standing under the supervision of a specialist, and passively active exercises are performed lying on his stomach and lying on his healthy side, from 5-6 days the patient actively begins to walk on crutches, on the 14-15 day after surgery, the patient is engaged in swimming under the supervision of a specialist with a busy duration 25-30 minutes.

Performing exercises at the third stage, lasting 16-45 days after surgery, the patient performs passive and active exercises, passively active exercises (lying on his back, sitting,

- 4 010788 standing) with complication, the introduction of a new set of exercises, an additional set of exercises in a liquid medium with the help of a specialist, under the supervision of a specialist with a duration of 25-30 minutes.

When performing exercises at the fourth stage, lasting 46-90 days after surgery, the patient performs passive, active, passively active exercises, lying on his back, sitting, standing, while active exercises are performed by the patient on their own, as well as using additional objects, inflatable balls, elastic bandage, with an increase in the number of repetitions, as well as standing in the unloading position, standing on a healthy foot, standing on two legs with the arms resting on the backs of chairs, etc., with a duration of 25-30 minutes.

When performing exercises at the fifth stage, lasting 91-180 days after the operation, the patient performs active exercises, increasing the load on the lower extremities, by increasing the number of repetitions and the inclusion of new exercises in the supine position, on the healthy side, sitting and standing in a liquid environment . Exercises are performed independently and under the supervision of a specialist, taking into account the individual state of health of the patient, his associated diseases. After 90 days, the patient switches to a cane, you can connect swimming with a duration of 25-45 minutes.

Then, the exercises at the sixth stage, which lasts 181 days after the operation and then throughout life, the patient exercises independently and under the supervision of a specialist, active exercises in the supine, stomach, side, sitting and standing in a liquid environment. A set of exercises is developed individually for each patient with a duration of 30-50 minutes.

The proposed method is as follows.

From the 1st day after the operation, with the help of a specialist, the patient is put on his feet by the bed for 3-10 s, on the 2nd day the patient stands by the bed for 5-10 s, on the 3-4th day he sits on the bed, then gets up by the bed, then takes several steps with the help of “walkers”, on the 5-6th day the patient switches to walking on crutches with the help and under the supervision of a specialist. On the 7-10th day, the patient is already actively walking on crutches, thereby improving the functioning of the thigh muscles, stabilizing the psycho-emotional state. Early activation of the patient improves blood circulation in the operated limb and strengthens the quadriceps femoris.

The proposed method eliminates the complications associated with dislocation in the joint by performing passive exercises with the help of a specialist, for example, from the 4th day, the specialist puts one hand under the knee fossa of the operated leg, the second under the ankle joint and takes the leg to the side, avoiding pain in damaged limb. Exercises are repeated from 5 to 15 times with the number of approaches from 3 to 5 times. In this case, the muscles of the controlled limb are completely relaxed, trophic processes in the area of damage are improved, and the exercise is especially important for elderly and senile patients. After surgery, the patient suffers from the proprioceptive apparatus and the performance of passive exercises with the help of a specialist ensures the absence of postoperative complications associated with dislocation of the endoprosthesis head.

The proposed method provides for the gradual restoration of the range of motion in the operated joint, the rehabilitation program is developed taking into account age, concomitant diseases, psychoemotional and general health of the patient, is implemented with any category of patients.

The essence of medical rehabilitation is determined by the targeted effect on the operated joint by performing systematic training, which helps to develop and stimulate the processes of adaptation and compensation.

This is of great importance for optimizing rehabilitation treatment, which requires the mobilization of the patient's volitional and physical efforts, as well as his confidence in success.

A good effect for the development of the movements of the operated joint is given by an exercise with an inflatable ball, which is performed while lying on the bed, leading the ball along the ball, resting on the ball, raising the pelvis 10-20 cm from the bed surface, alternately pressing the ball with the feet.

These exercises are accompanied by positive emotions, have a beneficial effect not only on the restoration of movements in the affected joints, but also on the general condition of the patient (increasing neuropsychological tone, training the cardiovascular system, activating the metabolism, etc.).

Exercises are carried out at an average pace, controlling the amplitude of movements in the operated joint. Performing exercises with the help of a specialist starts from 5 times, increasing them to 50 times, with objects repeated from 5 to 20 times. With an increase in the number of repetitions, the individual condition of the patient is taken into account.

They offer a rehabilitation program for patients after hip and knee arthroplasty, consisting of a set of therapeutic exercises that are performed mainly in 6 stages, divided by time intervals in compliance with the set of exercises, the patient’s behavior in the early postoperative period and the patient’s behavior in everyday life distant period.

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The patient’s rules of conduct reflect the exercises and positions that are shown and contraindicated in the early postoperative period and in the remote period in everyday life after hip and knee joint replacement.

The patient’s rules of conduct in the early postoperative period and in the long term after hip and knee arthroplasty are given to the patient’s hands in the form of a memo.

The following is contraindicated in the early postoperative period after hip replacement:

lie on the operated side;

sit on a low surface (bed, chair and toilet bowl);

to squat;

cross and lower legs;

on fixed legs turn the body to the side;

bend down below the waist;

to load the operated leg with walking;

sit in one position for more than 40 minutes;

to swim;

bend the operated leg in the hip joint more than 90 °;

internal rotation and reduction of the operated limb;

to get up and give axial load on the operated leg;

sit with a torso position of 90 °; bend down and hang from the edge of the bed to lift things off the floor; independently remove and wear shoes;

take a bath while lying down (preferably a shower);

wear shoes without a “heel” and high heels;

The following is shown in the early postoperative period after hip replacement:

lie on the healthy side, using a roller between the legs;

sit on a horizontal surface (chair, bed, etc.), which will be above the knee joints;

sit on a horizontal surface (chair, bed, etc.), while the distance between the legs (knees) should be 15-20 cm;

sit on a horizontal surface (chair, bed, etc.), while the feet should be completely on the floor;

when making a turn, turn the body and both legs at the same time;

use special exciting devices to lift objects from the floor; use special devices for putting on socks, tights, shoes;

use special devices for washing in the bathroom or shower; Wear shoes with a low stable heel with a fixed heel;

not long walks in the fresh air, using crutches or a wand;

between the legs should be a pillow.

The following is contraindicated in the early postoperative period after knee arthroplasty:

lie on the operated side;

sit on a low surface (bed, chair and toilet bowl);

to squat;

on fixed legs turn the body to the side;

to load the operated leg with walking;

sit in one position for more than 40 minutes;

to get up and give axial load on the operated leg;

take a bath while lying down (preferably a shower);

wear shoes without a “heel” and high heels;

The following is shown in the early postoperative period after knee arthroplasty:

lie on the healthy side, using a roller between the legs;

sit on a horizontal surface (chair, bed, etc.), which will be above the knee joints;

sit on a horizontal surface (chair, bed, etc.), while the feet should be completely on the floor;

when making a turn, turn the body and both legs at the same time;

use special exciting devices to lift objects from the floor; use special devices for putting on socks, tights, shoes;

use special devices for washing in the bathroom or shower;

- 6 010788 to wear shoes with a low stable heel with a fixed heel;

not long walks in the fresh air, using crutches or a wand;

between the legs should be a pillow.

The following is shown in the distant period after hip and knee arthroplasty:

physiotherapy;

massage;

swimming;

walks in the fresh air, but not long;

a ride on the bicycle.

The following is contraindicated in the long term after hip and knee arthroplasty:

jogging (jumping, running);

any movements associated with the fall and impact of the operated joint;

movements associated with abrupt descent and climbing stairs;

various sports (gymnastics, aerobics, soccer, downhill and water skiing, etc.).

To achieve a good result of the restoration of motor activity of the operated limb, the following conditions for the implementation of the rehabilitation program must be observed.

All exercises are performed simultaneously with breathing exercises, active exercises are performed independently and under the supervision of a specialist at a calm pace, passive exercises are performed with the help of a specialist in the supine position, thereby reducing the load on the spinal column, namely the lumbosacral spine, passively active exercises are performed independently and with the help of a specialist in the lightened positions of the lower limb.

Performing exercises with the help of a specialist helps the patient strengthen the thigh muscles, increase the range of motion in the operated joint, strengthen the abducent and adductor muscles of the operated thigh, stretch the ligamentous apparatus, which has great strength, low extensibility after surgery, which significantly slows down the moment of making movements in the joint at maximum volume, strengthen and stretch the muscles (extensors, abduction and flexors) of the operated limb.

Exercises are carried out with a gradual increase in the number of repetitions, an increase in the load, alternating with relaxation exercises using light massage with the help of a specialist who uses stroking, rubbing, light kneading of tense muscle groups. Massage increases muscle tone and fights muscle atrophy. Exercises are performed with caution associated with pain in the operated limb. The increase in load begins with a minimum, with a further gradual expansion of exercises and the connection from 1 day to 1 year of one, two exercises from the complex, with an increase in the number of repetitions.

The duration of classes, as a rule, depends mainly on the general condition of the patient.

A set of therapeutic exercises after hip replacement.

First stage.

From 1-3 days after the operation (lying, sitting, standing) the patient is taught to walk on "walkers".

The goal is the improvement of trophism and blood circulation in the operated joint, the prevention of deep vein thrombophlebitis, and an increase in the general tone of the patient.

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No. Starting position Exercises Reps Qty approaches Breathing movements Active movements in a healthy limb, perform at an average pace I. Lying on his back Flexion and extension of the knee 10-25 2-3 flexion inhalation, extension exhalation 2. Lying on his back Circular movements in the ankle joint 10-25 one way and the other 2-3 arbitrary breathing Rest as a patient, mainly 3 * 5 minutes 3. Lying on his back Stop by yourself. Raising a straight leg up 10 ° -15 ° from the surface of the bed and holding it for 3-5 seconds 2-3 2-3 raising inhale, lowering exhale Active movements in a diseased limb, performed at a slow pace Lying on his back Stop on / off 3-5 2-3 arbitrary breathing Passive movements in a diseased limb, performed at a slow pace with the help of a specialist one. Lying on his back Leaving the leg to the side by 1 (^ - 15 ¹¹ with the help of a specialist: one hand is placed under the knee fossa, the other under the ankle joint. At the same time, if possible, there should be complete relaxation of the muscles of the exercised limb. Try to prevent pain intensification during exercise. 3-5 2-3 abduction, adduction of exhalation Active-passive exercises are performed in healthy and diseased limbs.

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For you11ОЛНС1 πIч лн. и.ссшпп exercises. the patient with the help of a slowly expanding polyimpot of the reversed extremity lead to the position lying in the position of the eil as follows. Specialist fixes the operated limb on the floor with the knee fossa and the ankle joint, the patient rises from the bed at the elbows, the specialist holds the sore foot with both hands and slowly takes it away to the edge of the bed. The healthy limb of the patient moves according to the patient's sensations. Upon reaching the half-sitting position, the patient slowly turns, and the specialist lowers his foot and the patient sits on the bed. It is advisable to put a pillow on the patient’s floor so that the back position is less than 90 °. Under the legs, it is advisable to substitute a little bench so that the feet do not hang on the floor, the bending angle in the knee joints should be 50-70.

The distance between the hips should be 15-20 cm.

I. Sitting on the bed Alternating flexion and extension of the legs in the knee joints. The patient himself tries to bend and unbend the operated limb, and the specialist holds it. 3-5 2-3 extension inhalation, flexion exhalation 2. Sitting on the bed. The feet are on the bench exactly parallel to each other at a distance of 1520 cm. Alternately raising and lowering the feet up and down on fixed heels. 3-5 2-3 arbitrary breathing Rest as a patient, mainly 3-5 minutes Starting position - sitting with the transition to a standing position with the help of a specialist the patient is in position, sit with the help of a specialist, slowly gets up on both legs while the atom of the foot should be parallel to each other at a distance of 15-20 cm. The patient, resting with two hands on the edge of the bed, lowers his legs to the floor, begins to slowly move the body forward, while the specialist holds the patient by the side of the body and helps him to stand up. There should be walkers next to the bed. one. 1 day after operations Put the patient with the help of a specialist on his feet, then put the patient, then help him go to bed for 3-10 seconds 1-2 1-2 arbitrary breathing 1.1 2 day after surgery With the help of a specialist, put the patient on his feet and, if possible, allow him to stand on the walker, while the patient rests on the walker with both hands. 510 seconds 1-2 1-2 arbitrary breathing 1.2 3 day after surgery With the help of a specialist, put the patient on his feet and fixing him behind the torso with his hands, try to help him take several steps on the walkers. To teach the patient to walk on walkers. After walking on walkers, help the patient return to the position lying on the bed. 1-2 1-2 arbitrary breathing

Second phase.

From 4-15 days (lying, sitting, standing) the patient performs passive and active exercises. Passive exercises are performed in lightened starting positions and unloading positions of the joint (lying on your back, sitting, etc.), teach the patient how to walk on crutches. Active exercises are performed under the supervision of a specialist, mainly in a liquid environment in a sitting position.

The goal is to strengthen the muscular system, increase its performance, improve blood circulation in the joints, stimulate trophism and the fight against hypertrophic and atrophic phenomena in the muscles, increase the general tone of the body.

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No. Starting position Exercises Repeat Count NIY Number of approaches Breathing movements Active exercises in a healthy limb, perform at an average pace ^one Lying on his back Flexion and extension of the knee 10-25 3-5 flexion inhalation, extension exhalation 2 Lying back Circular movements in the ankle joint 10-25 one way and the other 3-5 arbitrary breathing Rest as a patient, mainly 3-5 minutes one Lying on his back Stop by yourself. Raising a straight leg up 2 ° -3 ° from the surface of the bed and holding it for 3-5 seconds 5-15 3-5 raising inhale, lowering exhale Active exercises in a sick limb, performed at a slow pace ^one Lying on his back Stop on / off 15-25 3-5 arbitrary breathing Passive exercises in a sick limb, performed at a slow pace with the help of a specialist. to Lying on his back Leaving the legs to the side on! Ο ^υ -25 ^υ Specialist's hands: one hand is placed under the knee fossa, the other under the ankle joint. At the same time, if possible, there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain to intensify during exercise. 5-15 3-5 abduction, adduction of exhalation 1.1 Lying on your back from 9-10 days Leaving the legs to the side by 20 ^υ -40 °. Specialist's hands: one hand is placed under the knee fossa, the other under the ankle joint. At the same time, if possible, there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 15-30 3-5 abduction, adduction of exhalation

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ί Light massage of the diseased limb

2. Lying on his back Raising the foot up 1 <Λ25 ° Specialist's hands: one hand is placed under the knee fossa, the other under the Kolsnosyugtyn joint. and there must be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 5-15 3-5 raising inhale, lowering exhale 2.1 Lying on your back from 9-10 days Raising the legs up to LP ⁿ -55 °. Specialist's hands: one hand is placed under the knee fossa, the other under the ankle joint, while possible there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 15-30 3-5 raising inhale, lowering exhale Active-passive exercises are performed in healthy and diseased limbs. With our help, the patient sits on the bed from a prone position. The distance between the hips should be 15-20 cm. From 5-7 days, the patient sits on his own, keeping his sore leg healthy. one Sitting on the bed. Alternating flexion and extension of the legs in the knee joints, while the patient himself tries to bend and unbend the operated limb, and the specialist holds it with his hands. 15-20 3-5 extension inhalation, flexion exhalation 1.1 Sitting on the bed, from 6-8 days Alternating flexion and extension of the legs in the knee joints. In this case, the patient himself tries to bend and unbend the operated limb without our help. 15-20 3-5 extension inhalation, flexion exhalation 2. Sitting on the bed. The feet are on the bench exactly parallel to each other at a distance of 1520 cm. Alternately raising and lowering the feet up and down on fixed heels. 10-20 3-5 arbitrary breathing Active movements in a liquid medium under the supervision of a specialist from 8-10 days. one. Sitting The feet are on the floor exactly parallel to each other at a distance of 15-20 cm. Alternately raising and lowering the feet up and down on fixed heels 10-20 3-5 arbitrary breathing 2. Sitting Alternating flexion and extension of the legs in the knee joints. 15-20 3-5 extension inhalation, flexion exhalation Rest as a patient, mainly 3-5 minutes 3. Sitting Simultaneous extension of the legs in the knee joints and their retention for 5-15 seconds 15-20 3-5 extension inhalation, flexion exhalation 4. Sitting Alternately lifting straight legs up ns over 90 ^e 15-20 3-5 Raising Inhale, Lowering Exhale Rest as a patient, mainly 3-5 minutes Starting position - standing, with the help of a specialist, teach the patient to walk on crutches

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The patient with the help of a specialist from a position sitting slowly put on both legs. The feet should be parallel to each other at a distance of 15-20 cm. one Xia Oya S 4 'DAYS Put the patient with a specialist pounding on his feet and fixing him behind the body, helping him to take several steps on the walkers. 2-3 3-5 arbitrary breathing 1.1 Standing from 5-6 days Put the patient with the help of a specialist on the grave and fixing him behind the body, helping him to take several steps on crutches. 2-3 3-5 arbitrary breathing 1.2 Standing from day ⁷ Under the supervision of a specialist, the patient walks on crutches independently. 2-3 3-5 arbitrary breathing Starting position - standing with two hands on the sides of the handrail, the specialist fixes the patient with his hands behind the body one. Standing from 9-10 days Focus on the hands. The transfer of body weight alternately to one, then to the other leg 3-5 sec body weight on a sore leg; 5-10 sec on a healthy leg 5-7 3-5 arbitrary breathing 2. Standing on a healthy foot Mahi forward sore foot angle 10-25 5-7 2-3 forward inhale, back exhale 2.1 Standing on a sore foot Maxi forward healthy leg angle 1O “-25 ® 3-5 2-3 forward inhale, back exhale Rest as a patient, mainly 3-5 minutes

The third stage.

From 16-45 days (lying, sitting, standing), the patient performs passive and active exercises with the complication of introducing a new set of exercises, an additional set of exercises in a liquid medium, which leads to an increase in the amplitude of movement in the operated joint.

The goal is to strengthen and restore trophism, tone and strength of the muscles of the trunk, lower extremities, restore movement in the operated joint with further warning of the limitation of its functions, increase the volume and amplitude in the operated joint, train the supporting function of the legs, increase the general tone of the body.

After performing the movements, the patient is given a light massage of the operated thigh (quadriceps muscle). Massage improves blood circulation, helps to reduce swelling and pain in a sore joint.

No. Starting position Exercises Repeat nn Number of approaches Breathing movements Active movements in a healthy limb, perform at an average pace one. Lying E1a on his back Flexion and extension of the knee 20-35 3-5 flexion inhalation, extension exhalation 2. Lying on your back Abduction of the leg to the side at 30 ^ -40 °. 10-25 3-5 abduction, adduction of exhalation

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Rest as sick. Nrsimup1esgreshu 3-5 mnpug h. Lying on his back Stop yourself. Raising a straight leg up by 20'-30 ⁽¹ from the surface of the bed and holding it for 3-5 seconds 5-7 3-5 raising a breath. descent) gis exhale Active movements in a sick limb, perform in a slow heme one Lying on his back Stop on yourself and keeping it in this position for 3-5 seconds. 15-25 3-5 piercing breath 1.1 Lying on his back Stop from yourself and keeping it in this position for 3-5 seconds. 15-25 3-5 ... arbitrary breathing Passive movements in a sick limb, do it! in slow dark with the help of a specialist one. Lying on his back Abduction of the leg to the side by 20 ¹¹ -40 °. Specialist's hands: one hand is placed under the knee fossa, the other under the ankle joint and, if possible, there should be complete relaxation of the mouse of the exercised limb. Try not to allow pain intensification during exercise. 20-30 3-5 abduction, adduction of exhalation 1.9 Lying on your back from 30-45 day Leaving legs to the side of the naked ¹¹ . Specialist's hands: one hand is placed under the knee fossa, the other under the ankle joint, while possible there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 30-50 3-5 abduction, adduction of exhalation Rest as a patient, mainly 3-5 minutes, light massage of a sick limb 1.2 Lying on his back Raising the legs up on ZO “-55 ^U. Specialist's hands: one hand is placed under the knee fossa, the other under the ankle joint. At the same time, if possible, there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 15-30 3-5 raising inhale, lowering exhale 1.3 Lying on his back from 30-45 days Raising legs up 55 ¹ '-70. Specialist's hands, one hand is placed under the knee fossa, the other under the ankle joint, and if possible there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 30-50 3-5 raising inhale, lowering exhale 2. Lying on his back The legs are bent at the knee joints to 90 °. The specialist sits on the couch next to the patient from the side operated 3-5 3-5 squeezing in, expanding out

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limbs The specialist’s hands are clenched into a fist and interfere between the patient’s knees. The patient’s task is to compress the specialist’s fist with his knees for 5-10 seconds. 2.1 Lying on his back The legs are bent at the knee joints to 90. The specialist sits on the couch next to the patient from the side of the operated limb. Our hand hugs the patient’s knees in the ring, i.e. the hand “goes away” under the knee of a healthy leg. The patient’s task is to raise the knees, while the specialist’s hand holds the patient’s knees firmly for 5-10 seconds. 3-5 3-5 breeding inhale, relaxation exhale 3. Lying on his back The legs are bent at the knee joints to 90 ^{4 The} specialist sits on the couch next to the patient from the side of the operated limb. The specialist’s hand holds the patient’s feet. The patient’s task is to raise the pelvis up by 10-15 cm 10-15 3-5 raising inhale, lowering exhale 4. Lying on his back A healthy limb is bent at the knee by 90 °. the operated limb lies in a horizontal position. The specialist sits on the couch next to the patient from the side of the operated limb. The specialist's hand holds the patient's foot. The patient’s task is to raise the pelvis up by 10-15 cm 5-7 3-5 raising inhale, lowering exhale Active exercises in healthy and diseased limbs are performed at a slow pace, under the supervision of a specialist one. Sitting on the bed. Alternating flexion and extension of the legs in the knee joints, while the patient himself tries to bend and unbend the operated limb without the help of a specialist. 20-30 3-5 extension inhalation, flexion exhalation 2. Sitting on the bed. The feet are on the bench exactly parallel to each other at a distance of 1520 cm. Alternately raising and lowering the feet up and down on fixed heels. 20-30 3-5 arbitrary breathing 3. Sitting on the bed Simultaneous extension of the legs in the knee joints and holding them 515 sec .. feet on yourself. 10-15 3-5 extension inhalation, flexion exhalation Active movements in a liquid medium under the supervision of a specialist one. Sitting Tables stand on the floor exactly parallel to each other at a distance of 15-20 cm. 20-30 3-5 arbitrary breathing

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Alternately raising and lowering the feet up and down on fixed heels. 2. With il 11ismorsnos flexion and extension of the knee joint. 30-40 3-5 extension inhalation, flexion exhalation Rest as a patient. mainly 3-5 minutes 3. S’ilya Simultaneous extension of the legs in the knee joints and their retention for 5-15 seconds 20-30 3-5 extension inhalation * flexion exhalation 4. Force Alternately lifting straight legs up to 90 ^e 20-30 3-5 raising inhale * lowering exhale 5. Sitting Leaving aside a healthy leg for 20-40 ’ 10-15 3-5 abduction, adduction of exhalation Starting position · standing * legs at a distance of 15-20 cm * feet parallel to each other, hands in front of them hold the handrail · one. Standing Toe toes 3-5 3-5 raising inhale, lowering exhale 2. Standing Squat 10-15 ° 3-5 3-5 down inhale, up exhale Pause During the day, the patient should walk on crutches several times a day. Starting position - standing with two hands on the sides of the handrail, the specialist fixes the patient with his hands behind the body one. Standing Focus on the hands. The transfer of body weight alternately on one leg, then on the other leg, body weight on a sore leg 3-5sec. on a healthy leg 5-10 sec 7-10 3-5 arbitrary breathing 2. Standing on a healthy NOTE Mahi forward sore foot angle 1Ο ^υ · 25 “ 7-10 2-3 forward inhale, back exhale 2.1 Standing on a sore foot Mahi forward healthy leg angle 10 ^and -25 0 5-10 2-3 forward inhale, backward exhale 3. Standing Squat 10-15 3-5 2-3 down inhale, up exhale Rest as a patient, mainly 3-5 minutes

The fourth stage.

From 45-90 days the patient performs passive and active exercises with increasing effort (with overcoming resistance, for example, an elastic bandage, inflatable balls), with an increase in the number of repetitions, as well as in unloading positions (standing on a healthy leg, standing on two legs with an emphasis on the hands on the backs of chairs, etc.), and also continues to exercise in a liquid environment.

Up to 90 days, the patient is recommended to walk on crutches.

The goal is to strengthen the muscle system of the lower extremities and the lumbosacral spine, stretch and elasticize the ligamentous apparatus, fight muscle atrophies, stimulate metabolic processes through weight-bearing movements, walk, half squat and perform exercises with increasing effort, training the cardiovascular system , increasing the overall tone of the body.

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No.> Starting position Exercises Repeat Count Number of approaches Respiratory movement Ak1IEN1b1C movement η healthy limbs, perform in the middle of the dark one. Lying Ηίΐ back Knee flexion and wounds 20-35 3-5 C1bapie inhalation, exhalation extension 2. Lying on a slip On putting feet to the side at 30 ^ -40 ¹¹ . 10-25 3-5 abduction, adduction of exhalation 3. Lying on his back Raise a straight leg at 70 ° -80 and perform circular movements, with the toe of the tables draw a circle first in one direction and then the other. 5-10 3-5 arbitrary breathing Rest as a patient, mainly 3-5 minutes 4. Lying on his back Stop by yourself. Raising a straight leg up 20 ^ -30 ° from the surface of the bed and holding it for 3-5 seconds 5-7 3-5 raising inhale, lowering exhale 5. Lying on his back Swing up to 60 " 5-10 3-5 raising legs inhale, lowering exhale 6. Lying on his back Imitation cycling 5-10 3-5 arbitrary breathing Passive movements in a diseased limb, performed at a slow pace with the help of a specialist, one Lying on his back Leaving the legs to the side at 20 ^υ -40 ^υ . Specialist's hands: one hand is placed under the knee fossa, the other under the ankle joint, and if possible there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 30-50 3-5 abduction, adduction of exhalation 2 Lying on his back Flexion and extension of the leg in the knee joint. The angle of flexion in the knee joint is 90 degrees parallel to the bed, and in the hip joint to 90. One specialist’s hand is placed under the calf muscle, and the other under the ankle joints. 30-50 3-5 3 Lying on his back It is performed on the relaxation of the patient. The specialist sits on the patient’s bed at the level of the ankle joints, from the side of the operated limb. The specialist’s task is to take the patient’s leg, put it on the opposite shoulder relative to the patient’s position. The specialist’s hand, on which the patient’s foot is located, holds his foot, the specialist’s other hand on the patient’s knee joint. The specialist bends the foot with his hand at himself at the same time, unbending the knee joint. As a patient 3-5 3-5 extension exhalation, flexion inhalation

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hold in the same position .1-10 sec. 4 Lying on his back Without getting out of bed and without removing the feet from the specialist’s shoulder, with his body and shoulder bends and unbends the patient’s foam to 90. 3-5 3-5 breathless breath Rest - light massage of a sick limb 5 Lying on his back Raising a straight leg up 55-7O. Specialist hands :, one hand is placed under the knee fossa, the second floor is the ankle joint, while if possible there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 30-50 3-5 raising inhale, lowering exhale 6 Lying on his back The legs are bent at the knee joints to 90. The specialist sits on the couch next to the patient from the side of the operated limb. The specialist’s hand is clenched in a fist and placed between the knees of the patient. The patient’s task is to compress the specialist’s fist with his knees for 5-10 seconds. 5-10 5-10 squeezing inhale 6.1 Lying on his back The legs are bent at the knee joints to 90 “The specialist sits on the couch next to the patient from the side of the operated limb. The specialist’s hand hugs the patient’s knees in the ring, i.e. the hand "goes" under the knee of a healthy leg. The patient spreads his knees, the specialist’s hand holds the patient’s knees firmly for 5-10 seconds. 5-10 5-10 breeding inhale, relaxation exhale 7. Lying on his back The legs are bent at the knee joints to 90. The specialist sits on the couch next to the patient from the side of the operated limb. The specialist's hand holds the patient's foot. The patient’s task is to raise the pelvis up by 10-15 cm 10-15 3-5 raising inhale, lowering exhale 8. Lying on his back A healthy limb is bent at the knee by 90 °. The operated limb lies in a horizontal position. The specialist sits on the couch next to the patient from the side of the operated limb. The specialist's hand holds the patient's foot. The patient’s task is to raise the pelvis up by 10-15 cm 5-7 3-5 raising inhale, lowering exhale

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ΙΟ. Lying on the blue The operated final,! · Is bent in the knee joint to 90. A healthy limb lies horizontal. The specialist sits on the couch next to the patient from the side of the operated limb. The specialist's hand holds the patient's foot. The patient’s task is to raise the pelvis up by 10-15 cm 5-7 3-5 raising inhale, lowering exhale Active exercises in healthy and diseased limbs are performed at a slow pace, under the supervision of a specialist one Lying on his back The legs are straight. Alternating bending of the leg of the knee joints. In this case, the heel does not tear off the surface. 10-15 3-5 arbitrary breathing 2 Lying on his back The legs are bent at the knee by 90 °. Alternating bending of the legs in the hip joints to 90 °. 10-15 3-5 arbitrary breathing 3 Lying on his back Movement for resistance. Bend the note in the knee joint at 50 ° 70 °. Pick up an elastic bandage, with the help of a specialist, throw it on the foot, and give the patient two free ends in his hands. The bandage should be stretched, the patient tries to straighten the leg. While holding the ends of the elastic bandage with his hands. Then bend your leg back in sp 5-10 3-5 bend inhale, bend exhale 4 Lay back The specialist puts an inflatable ball on the bed under the patient’s knees. The bending angle in the hip joints should be no more than 90 °. The patient’s task is to press the ball for 3-5 seconds with both feet. 5-10 3-5 arbitrary breathing 5. Lying on his back The specialist puts an inflatable ball on the bed under the patient’s knees. The bending angle in the hip joints should be no more than 90 °. The task of the patient alternately catching the ball on the ball for 3-5 seconds. 5-10 3-5 arbitrary breathing 6, Lying on his back The specialist puts an inflatable ball on the bed under the patient’s knees. The bending angle in the hip joints should be no more than 90 °. The task of the patient with both legs to try to roll the ball back to his heels and roll it back. The specialist’s hands are on the patient’s legs and slightly support the legs in the correct position. 5-10 3-5 arbitrary breathing 7 Lying on his back Specialist puts on the bed under 5-10 3-5 arbitrary breathing

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knees of the patient an inflatable ball. The bending angle in the hip joints should be no more than 90 ^liters . The patient's task, resting on the ball with both legs, raise the pelvis up by 10-15 cm and hold it for 3-7 seconds. The specialist holds the ball with his hands. 8 Lying on his back Specialist treasure! on a bed under the patient’s knees an inflatable ball The angle of flexion in the hip joints should be no more than 90 °. The patient's task is to simultaneously bend and unbend the ankle joints. 5-10 3-5 arbitrary breathing Light relaxing massage nine Sitting on the bed. At the same time, straighten the legs in the knee joints and hold them for 5-15 seconds., Feet on yourself 10-15 3-5 extension inhalation, flexion exhalation 10 Sitting Try to bend and unbend legs in the knee joints at a fast pace. In this case, one leg is bent, and the other is bent 10-15 3-5 arbitrary breathing n Sitting Unbend both legs at the knee joints and bend and unbend at the ankles in weight at an average pace 10-15 3-5 arbitrary breathing 12 Sitting The legs are bent at the knee joints. Alternately raising legs up in the hip joints 10-15cm from the bed surface 10-15 3-5 arbitrary breathing Active movements are performed in a liquid medium under the supervision of a specialist one. Sitting The feet are on the floor parallel to each other at a distance of 15-20 cm. Alternately raise and lower the feet up and down on fixed heels. 20-30 3-5 arbitrary breathing 2. Sitting Alternately bend and extend the legs in the knee joints. 30-40 3-5 extension inhalation, flexion exhalation

Rest as a patient, mainly 3-5 minutes

3. Sitting Simultaneous extension of the legs in the knee joints and their retention 10-25 sec 20-30 3-5 extension inhalation, flexion exhalation 4. Sitting Alternately lifting straight legs up to 90 ° 20-30 3-5 raising inhale, lowering exhale 5. Sitting Lead to the side of a healthy leg at 2040 ^e 10-15 3-5 abduction adduction exhale 6. Sitting The legs are bent at the knee joints. Alternately raise your legs up in 10-15 3-5 arbitrary breathing

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Arbitrary breathing

Arbitrary breathing

surface of the bed Imitation of cycling side.

hip joints 10-15cm away

Alternately raise your straight leg and toe a circle into one and the other

Pause

nine. ! Sitting from day 70 The legs are extended in the knee joints. Exercise "scissors", perform smoothly. 10-15 3-5 Arbitrary breathing 10. Sitting Both limbs are extended in the knee joints, at the same time perform circular movements in the ankle joints, in one and the other direction. 10-15 3-5 Arbitrary breathing eleven. Sitting Both limbs are unbent in the knee joints, at the same time perform flexion and extension in the ankle joints, sock on and off. 10-15 3-5 Arbitrary breathing 12. Sitting Legs shoulder width apart, feet parallel to each other. At the same time, mixing and spreading the feet to each other, returning to ip *, while the feet should be kept without tearing off the floor surface. 10-15 3-5 Arbitrary breathing Starting position - standing, legs at a distance of 15-20 cm, feet parallel to each other ', hands in front of themselves hold on to the handrail. one. Standing Toe toes 10-15 3-5 Raising inhale, lowering exhale 2. Standing Squat 10-15 5-10 3-5 Down inhale, up exhale 3. Standing Alternating abduction of straight legs to the side no more than 20-30 ° and return to I. 5-10 3-5 Arbitrary breathing 4. Standing Alternating abduction of the straight leg back ns more than 20-30 ° and return to I. p. 5-10 3-5 Arbitrary breathing Pause 5. Standing Stand sideways at the handrail, holding on to it with one hand. Standing on a healthy limb, raise the straight operated leg up no more than 2030 ° and lower it in the I.P. 5-10 3-5 Arbitrary breathing 6. Standing Stand sideways at the handrail, holding on to it with one hand. Standing on a healthy limb, take the operated leg to the side no more than 20-30 ° and return to I. p. 5-10 3-5 Arbitrary breathing 7. Standing Stand sideways at the handrail, holding on to it with one hand. Walking forward in small steps, 5-10 steps in one direction and the other, 5-10 3-5 Arbitrary breathing

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8. 1 standing Stand sideways at the handrail, holding on to it with one hand. Walking forward with long steps (step no more than 1 meter), 5-10 steps and one and the other side. 5-1 (1 3-5 ; Arbitrary breathing Pause nine. Standing Stand sideways at the handrail, holding on to it with one hand. Walking back in small steps, 5-10 steps in one direction and the other. 5-10 3-5 Arbitrary breathing 10. Standing Stand sideways at the handrail, holding on to it with one hand. Walking back in long steps (step no more than 1 meter), 5-10 steps in one direction and the other. 5-10 3-5 Arbitrary breathing Pause During the day, the patient walks on crutches several times a day. The initial position is the emphasis with both hands on the sides of the handrail, the specialist fixes the patient with his hands behind the trunk. one. Standing Focus on the hands. Transferring body weight alternately to one, then to the other leg for 5-10 seconds, body weight to a sore leg; 10-15 sec on a healthy leg 7-10 3-5 Arbitrary breathing 2. Standing on healthy leg Mahi forward a sore foot corner 1О “-25“ 7-10 2-3 forward inhale, backward exhale 3. Standing on a sore foot Mahi forward healthy leg angle 10 ° -25 0 5-10 2-3 forward inhale, backward exhale Rest as a patient, mainly 3-5 minutes 4. Standing Squat 10-15 " 5-10 2-3 Down inhale, up exhale 5. Standing on a healthy leg Operated leg to bend the knee to 90 ^minutes, and then, making a move back to straighten it, put on a sock, while bending the healthy limb. 5-10 2-3 Arbitrary breathing 6. Standing on a sore foot Bend a healthy leg in the knee joint to 90 °, then, having made a swing back, unbend it, put it on the toe, while bending the operated limb. 5-10 2-3 Arbitrary breathing 7. Standing Alternately simulate cycling, first standing on a healthy, and then on an operated limb 5-10 2-3 Arbitrary breathing 8. Standing Alternately swing the legs straight and forward, first standing on a healthy, and then on the operated limb 5-10 2-3 Arbitrary breathing Rest as a patient, mainly 3-5 minutes

The fifth stage.

From 91-180 days the patient performs active exercises with an increase in the load on the lower extremities by increasing the number of repetitions, taking into account the individual condition of the patient, his concomitant diseases, as well as the introduction of new exercises in the supine position, on the healthy side, as well as sitting and standing in a liquid medium.

Exercises can be performed both independently by the patient, and under the supervision of specialists.

After 90 days, depending on the condition of the patient, you can switch to a cane.

After 90 days, the patient can swim.

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No. 1 Original position Exercises Qty repetitions Number of approaches Breathing movements Active exercises are performed in healthy and diseased limbs at an average pace on their own one I lying on my stomach The legs are straight. 10-20 3-5 Arbitrary breathing hands along Alternating bending and torso extension of the legs in the knee joints. In this case, pull the heel to the buttocks. 2 Lying on his stomach Alternating lead 10-20 3-5 Arbitrary breathing hands along straight legs to the side for 30- torso 40 ° with this toe glide over the surface the beds. 3 Lying on his stomach Alternating uplift 10-20 3-5 Arbitrary breathing hands along straight legs up from torso bed surface on 10- 15cm 4 Lying on his stomach Alternate execution 10-20 3-5 Arbitrary breathing hands along movement. One leg is straight. torso the other is bent at the knee 90® joint. Bent leg in the knee joint lift up, while tearing it off the surface beds up to 10cm. 5 Lying on his stomach Dilute the legs by 20-25 cm. 10-20 3-5 Arbitrary breathing hands along Alternately raise straight torso legs up from the bed surface by 10-15cm. and hold for 3-1 Osek. Source Qty Qty No. position Exercises repetitions approaches Breathing movements Asset th exercises in a healthy and diseased limb ι average t umpe yourself one Lying on The legs are straight, the sock on yourself. 10-20 3-5 Arbitrary breathing healthy side with Raise straight leg up roller between 10-20 cm. and hold 3- feet Yusek. 2 Lying on Healthy leg is straight. 10-20 3-5 Arbitrary breathing healthy side with the patient is bent at the knee E ^ alik between 90 ° joint. Lift up feet bent leg 10-15cm. 3 Lying on Healthy leg is straight 10-20 3-5 Arbitrary breathing healthy side with abduction of a direct patient you between legs back from 20 to 40 * ’ feet 4 Lying on Healthy note and straight, max 10-20 3-5 Arbitrary breathing healthy side forward with a sore foot up to 45 °. roller between nsg

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The sixth stage.

From 181 days onwards, throughout life, a complex of active exercises is carried out in the supine, abdominal and lateral positions, as well as sitting, standing, exercises in a liquid medium are also shown according to an individual program developed for the patient. Exercises can be performed both independently by the patient, and under the supervision of a specialist.

As a result of the rehabilitation program, the amplitude of movement in the hip joint during bending reaches more than 95 °, during abduction it reaches more than 20 °, with external rotation more than 35 °, and with internal rotation more than 20 °.

Examples of the method.

Patient N., 34 years old. Rheumatoid arthritis, aseptic necrosis of the heads of the right and left femurs. An operation on the endoprosthesis replacement of the right hip joint was performed in April 2000, and the operation of the left hip joint in July 2000.

In the preoperative period, psychological and informational preparation of the patient for the upcoming operation was conducted, the shown and contraindicated behavior in the early postoperative and distant periods were studied.

After the operation of endoprosthetics of the right and then the left hip joint, the patient carried out a rehabilitation program to restore the motor activity of the operated joint, which was carried out in 6 stages. On the 1st day after the operation, with the help of a specialist, the patient was put on his feet by the bed for 5-10 seconds, On the 2nd day, the patient began to walk with the help of a specialist on “walkers”. Passive, passively active and active exercises were performed with the help of a specialist and under the supervision of a specialist in the initial positions: lying on his back, sitting, standing and in a liquid environment.

From the 5th day to 3 months, the patient walked on crutches, from the 6th day the exercises were performed with the help of a specialist, under the supervision of a specialist, independently, adhering to the above recovery program.

After 3 months, the patient began to walk without additional support, does not limp, has good muscle tone in the lower extremities, returned to a full life, entered the institute, and went to work. Currently works, travels to relax, maintains physical fitness with the help of medical gymnastics, exercise bike and swimming; according to x-ray studies of the operated joint, the condition of the endoprosthesis in the bone tissue is stable.

Patient V., 64 years old. Aseptic necrosis of the femoral head and the roof of the acetabulum of the left hip joint. An operation on endoprosthetics of the left hip joint was performed in 2001.

In the preoperative period, psychological and informational preparation of the patient for the upcoming operation was conducted, the shown and contraindicated behavior in the early postoperative and distant periods were studied.

After the operation of endoprosthetics of the left hip joint, the patient underwent a rehabilitation program to restore the motor activity of the operated joint, which was carried out in 6 stages. On the 1st day after the operation, with the help of a specialist, the patient was put on his feet by the bed for 5-10 seconds, on the 2nd day the patient began to walk with the help of a specialist on “walkers”. Passive, passively active and active exercises were performed with the help of a specialist and under the supervision of a specialist in the initial positions: lying on his back, sitting, standing and in a liquid environment in a healthy and operated limb.

From the 5th day to 3 months the patient walked on crutches, from the 6th day the exercises were performed with the help of a specialist, under the supervision of a specialist, independently, adhering to the above recovery program.

After 3 months, the patient began to walk without additional support, does not limp, has good muscle tone in the lower extremities, and returned to a full life. Currently, according to x-ray studies of the operated joint, the state of the endoprosthesis in the bone tissue is stable.

Patient M., 22 years old. Rheumatoid arthritis, coxarthrosis 4 tbsp. right hip joint. Right hip joint arthroplasty was performed in 2003.

In the preoperative period, psychological and informational preparation of the patient for the upcoming operation was conducted, the shown and contraindicated behavior in the early postoperative period and in the remote periods were studied.

After the operation of endoprosthetics of the right hip patient, a rehabilitation program was carried out to restore the motor activity of the operated joint, which was carried out in 6 stages. On the 1st day after the operation, with the help of a specialist, the patient was put on his feet by the bed for 5-10 seconds, on the 2nd day the patient began to walk with the help of a specialist on “walkers”. Passive, passively active and active exercises were performed with the help of a specialist and under the supervision of a specialist in the initial positions: lying on his back, sitting, standing and in a liquid environment in a healthy and operated limb.

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From the 5th day to 3 months, the patient walked on crutches, from the 6th day the exercises were performed with the help of a specialist, under the supervision of a specialist, independently, adhering to the above recovery program.

After 3 months, the patient began to walk without additional support, does not limp, has good muscle tone in the lower extremities, returned to a full life, went to work. Currently working, leading an active lifestyle, according to x-ray studies of the operated joint, the state of the endoprosthesis in the bone tissue is stable.

A set of therapeutic exercises after knee replacement.

First stage.

From 1-3 days after the operation (lying, sitting, standing) the patient is taught to walk on "walkers".

The goal is the improvement of trophism and blood circulation in the operated joint, the prevention of deep vein thrombophlebitis, and an increase in the general tone of the patient.

No. Source position Exercises Reps Number of approaches Breathing movements Active movements in a healthy limb, perform at an average pace one. Lying on his back Flexion and extension of the knee 10-25 2-3 flexion inhalation, extension exhalation Lying on his back Circular movements in the ankle joint 10-25 one way and the other 2-3 arbitrary breathing Rest as a patient, mainly 3-5 minutes 3. Lying on his back Stop by yourself. Raising a straight leg up 10 ° -15 ° from the surface of the bed and holding it for 3-5 seconds 2-3 2-3 raising inhale, lowering exhale Active movements in a diseased limb, performed at a slow pace one. Lying on his back Stop on / off 3-5 2-3 arbitrary breathing Passive movements in a diseased limb are performed at a slow pace with the help of a specialist. 2. Lying on his back Flexion and extension of the leg in the knee joint from 20 ^: -45 °. Hands of a specialist: one hand is placed below the knee fossa, the second under the ankle joint. In this case, if possible, there should be complete relaxation of the muscles of the exercised limb. Try not to allow pain intensification during exercise. 3-5 2-3 Flexion inhalation, extension exhalation

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h. ) K'J; 1 gga back Bending and raiding the legs in the knee joint from 2 (1-45 and holding in the flexion position for 3-5 seconds. Specialist hands: one hand is placed below the knee fossa, the other under the ankle joint. At the same time, there should be complete relaxation of the muscles of the exercised limb Try to prevent pain intensification during exercise. 3-5 2-3 Flexion inhalation, extension exhalation Active-passive exercises in healthy and diseased limbs. To perform further exercises, the patient with the help of a specialist is slowly raised from the side of the operated limb, brought from a position while lying in a sitting position as follows. The specialist fixes the operated limb under the knee fossa and ankle joint, the patient rises from the bed at the elbows, the specialist holds the sore foot with both hands and slowly takes it to the side to the edge of the bed. The healthy limb of the patient moves according to the sensations of the patient. Upon reaching a half-sitting position, the patient slowly turns, and the specialist lowers his leg down and the patient sits on the bed. It is advisable to put a pillow under the patient's back so that the back position is less than 90 °. It’s advisable to place a small bench under your feet so that your feet do not hang above the floor, the angle of flexion in the knee joints should be 50-70. The distance between the hips should be] 5-20 cm. one. Sitting on the bed. Flexion and extension of a healthy limb in the knee joint. With an atom, the patient tries to bend and unbend the operated limb, and the specialist holds it with his hands. 3-5 2-3 Extension inhalation, flexion exhalation 2. Sitting on the bed. Flexion and extension of the operated limb in the knee joint. In this case, the patient himself tries to bend and unbend the operated limb, and the specialist holds it with his hands. 3-5 2-3 Extension inhalation, flexion exhalation 3. Sitting on the bed. The feet are on the bench exactly parallel to each other at a distance of 15-20 cm. Alternately raising and lowering the feet up and down on fixed heels. 3-5 2-3 arbitrary breathing Rest as a patient, mainly 3-5 minutes Starting position - sitting with the transition to a position, standing, with the help of a specialist

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And> position, sitting patient with the help of a specialist. both legs are placed slowly on, moans should be parallel to each other at a distance of 15-20 cm, the patient rests with both hands on the edge of the bed. lowering the legs to the floor, the body begins to slowly move forward, while the specialist holds the patient by the side of the body and helps him to stand on his feet, there should be walkers next to the bed.

one 1 day after surgery With the help of a specialist, put the patient on his feet, then put him and then help him lie in bed for 3-10 seconds. 1-2 1-2 Arbitrary breathing 1.1 2 day after surgery With the help of a specialist, put the patient on his feet, if possible let him stand on the walker, while the patient relies on them with both hands for 5-10 seconds. 1-2 1-2 Arbitrary breathing 1.2 3 day after surgery With the help of a specialist, put the patient on his feet and fixing him behind the torso with his hands, trying to help him take several steps on the walkers. The specialist teaches the patient to walk on the walker. After walking on the walker, help the patient return to the position lying on the bed. 1-2 1-2 Arbitrary breathing

Second phase.

From 4-15 days (lying, sitting, standing) the patient performs passive and active exercises. Passive exercises are performed in lightened starting positions, as well as in the positions of joint unloading (lying on your back, sitting, etc.). Training a patient to walk on crutches.

Passive-active exercises are performed on the stomach, on the healthy side.

Active exercises are performed under the supervision of a specialist mainly in a liquid environment while sitting and standing.

From the 14-15th day after the operation, swimming under the supervision of a specialist is recommended.

The goal is to strengthen the muscular system and increase its performance, improve blood circulation in the joints, stimulate trophism and fight against hypertrophic and atrophic phenomena in the muscles, increase the flexion angle in the operated knee joint from 30 to 70 °, increase the general tone of the body.

No. Starting position Exercises Reps Number of approaches Breathing movements Active movements in a healthy limb, perform at an average pace one. Lying on his back Circular movements in the ankle in one direction and the other 10-25 3-5 arbitrary breathing 2 Lying on his back Flexion and extension in knee joint 10-25 3-5 flexion inhalation, extension exhalation Rest as a patient, mainly 3-5 minutes 3 Lying on his back Stop by yourself. Lift straight leg up 20 ^ -30 ^ from 10-15 3-5 raising inhale, lowering exhale

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and the surface of the bed and hold} " ss 3-5ssk Active movements in the diseased limb, perform and slow pace one Lying on his back Stop on / off 5-15 3-5 arbitrary breathing 2 Lying on his back Foot PA yourself and hold 5-1 Misfire, away from yourself and hold 5-10sec. 5-15 3-5 arbitrary breathing Passive movements in a diseased limb are performed at a slow pace with the help of a specialist. Exercises are performed with complete relaxation of the muscles of the exercised limb. Avoid intensifying pain during exercise. one. Lying on his back Abduction of the leg to the side up to 40 °. When performing the exercise, the specialist’s hands are: one under the knee fossa, the other on the ankle joint. 15-30 3-5 Abduction, adduction of exhalation 2. Lying on his back The operated limb is bent at the knee joint, the healthy one is bent. With the bent position of the operated limb, the specialist with his hands with effort increases the angle of bending by pressing on the knee joint, to mild pain, then the limb extends and relaxes. 5-10 3-5 Arbitrary breathing 2.1 Lying on his back from 9-10 days The operated limb is bent at the knee joint, the healthy one is bent. With the bent position of the operated limb, the specialist with his hands with effort increases the angle of bending by pressing on the knee joint, to mild pain, then the limb extends and relaxes. 10-20 3-5 Arbitrary breathing one. Lying on your back ' Raise a straight leg up from the bed surface by 40-60 cm and perform bending and extension in the knee joint. Bending angle from 30 to 55 °. The specialist holds the leg 'with one hand below the knee fossa, the other ankle joint. 10-20 3-5 Arbitrary breathing

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II Lying on the blue from 9-10 days Raise a straight leg up from the bed surface to 40-60 cm. And perform flexion and extension in the knee joint. The bending angle is from 50 to 70. The specialist holds the yen with one hand below the knee fossa, the other ankle joint. 10-20 3-5 Arbitrary breathing 1.2 Lying on his back Raise a straight leg up from the bed surface by 40-60 cm and perform bending and extension in the knee joint. Bending angle from 30 to 55 ¹⁵ . In the flexion position, keep the foot in this position for 5-10 seconds. The specialist holds the leg with one hand below the knee fossa, the other ankle joint. 10-20 3-5 Arbitrary breathing 1.3 Lying on your back from 9-10 days Raise a straight leg up from the bed surface by 40-60 cm and perform flexion and extension in the knee joint. Bending angle from 50 to 70 °. In the flexion position, keep the foot in that position for 5-10 seconds. The specialist holds the leg with one hand below the knee fossa, the other ankle joint. 10-20 3-5 Arbitrary breathing

Active-passive exercises in healthy and diseased limbs.

With the help of a specialist, the patient sits on the bed from a prone position. The distance between the hips should be 15-20 cm. From 5-7 days, the patient sits on his own, keeping his sore leg healthy. one. Lying on his back Both legs are straight. The distance between the legs is 50 bOsm. Alternately pulling the legs together, while sliding the heel on the bed surface. Specialist hands helps the operated limb. 10-20 3-5 Pulling in a breath, sm. exhale 2. Lying on your back from 9-10 days Exercises "scissors". Specialist supports operated limb. 5-15 3-5 arbitrary breathing 3. one______________________________ Lying on your back from 9-10 days The legs are bent at the knee joints. The distance between the feet is 20-30 cm. Alternating 10-20 3-5 arbitrary breathing

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while maintaining the bent The specialist helps the patient roll over on his stomach from the side of a healthy leg, supporting the operated leg with his hands. one. Lying on your stomach belly arms Alternating flexion and extension of the legs in the knee joints. The specialist holds the operated limb and. 10-15 3-5 Extension inhalation, flexion exhalation 1.1 Lounger stomach hands along torso Flexion and extension of the operated limb in the knee joint, and holding in the position of flexion for 5-10 seconds. Healthy leg is straight. The specialist holds the operated limb with his hands. 10-15 3-5 flexion inhalation, extension exhalation 2. Lying on your stomach hands along the torso from 9-10 days. Legs are straight, the distance between the legs is 30-40cm, Alternately raising straight legs up from the bed surface by 5-10cm, 10-15 3-5 flexion inhalation, extension exhalation one. He took off on the bed. Simultaneous extension of the legs in the knee joints. The specialist holds the operated limb with his hands. 10-15 3-5 Extension of the breath. flexion exhale 2. Sitting on the bed. Extension of the operated limb in the knee joint with a healthy leg. A healthy leg is brought under the operated leg and extends it. 10-15 3-5 Extension inhalation, flexion exhalation Rest in the patient’s condition, mainly 3-5 minutes, light massage of the operated limb 3. Sitting on the bed. Alternating flexion and extension of the legs in the knee joints. The specialist holds the operated limb with his hands. 15-20 3-5 Extension inhalation, flexion exhalation 4. Sitting on the bed. Feet stand on a bench parallel to each other at a distance of 15-20 cm. Alternately raising and lowering the feet up and down on fixed heels. 10-20 3-5 arbitrary breathing 5. Sitting on the bed from 9-10 days Exercises "scissors". Specialist supports 5-15 3-5 arbitrary breathing

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operated final and .. Snsialnsg helps the patient roll over gay healthy side and klakt him a roller between his legs. one. Lying on a healthy limb. Flexion and extension in the ankle joint 5-15 3-5 arbitrary breathing 2. Lying on a healthy limb. from 9-10 days. Sock on yourself, raise your straight leg up by 5-10cm. The specialist holds the operated limb with his hands. 5-15 3-5 arbitrary breathing 3. Lying on a healthy limb. from 9-10 days. Sock on yourself. Take the straight leg back 5-10cm. The specialist holds the operated limb with his hands. 5-15 3-5 arbitrary breathing 4. Lying on a healthy limb. from the 9th day. Sock on my own. Straight leg on 5-10cm. forward, Specialist holds the operated limb. Hands. 5-15 3-5 arbitrary breathing Active movements in a liquid medium under the supervision of a specialist from 8-10 days. I Sitting The feet are on the floor exactly parallel to each other at a distance of 15-20 cm. Alternately raising and lowering the feet up and down on fixed heels. 10-20 3-5 arbitrary breathing 2 Sitting Alternating flexion and extension of the legs in the knee joints. At the same time, try to bend the operated limb to 70 ° 15-20 . . .. 3-5 extension inhalation, flexion exhalation Rest as a patient, mainly 3-5 minutes 3 Sitting Simultaneous extension of the legs in the knee joints and their retention for 5-15 seconds. 15-20 3-5 extension inhalation, flexion exhalation 4. . Lying and sitting Exercises "scissors". Raising both legs up 30- 50 cm from the surface of the bed and perform a movement. 15-20 3-5 Arbitrary breathing Rest as a patient, mainly 3-5 minutes Starting position - standing, to train the patient to walk on crutches, with the help of a specialist From the position of sitting the patient with the help of a specialist, slowly put on two legs. The feet should be parallel to each other, at a distance of 15-20 cm. one. Standing from 4 days after operations With the help of a specialist, put the patient on his feet, fixing him behind the trunk. 2-3 3-5 Arbitrary breathing

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sick delas! steps on the walker. 1.1 Standing from 5-6 days after therapies With the help of a specialist, put the patient on the No ™, fixing him behind the body, the patient takes steps on crutches. 2-3 3-5 Arbitrary breathing 12 Standing from 7 days after operations Under the supervision of a specialist, the patient independently cares on crutches. 2-3 3-5 Arbitrary breathing Starting position - with two hands standing on each side of the handrail, the specialist fixes the patient with his hands behind the body behind one. Standing from 9-10 days Focus on the hands. Transfer of body weight alternately to one leg, then to the other leg, body weight on a sore leg Z-5sec; on a healthy leg - 5-10 sec 5-7 3-5 Arbitrary breathing 2 Standing on a healthy foot Mahi forward sore foot angle! 0 ° -25 ^s ' 5-7 2-3 forward inhale, back exhale 3. Standing on a sore foot Mahi forward healthy leg angle 10 ° -25 ° 3-5 2-3 forward inhale, back exhale Rest as a patient, mainly 3-5 minutes

The third stage.

From 16-45 days (lying, sitting, standing), the patient performs passive and active exercises with complication, the introduction of a new set of exercises, an additional set of exercises in a liquid medium, which leads to an increase in the amplitude of motion in the operated joint.

The angle of flexion of the knee joint reach from 70 to 90 °.

The goal is to strengthen and restore trophism, tone the strength of the muscles of the trunk and extremities, restore movement in the operated joint with further warning of limitation of its function, increase the volume and amplitude in the operated joint, train the supporting function of the legs, increase the general tone of the body.

Reps

Exercises

Breathing movements

Active movements in a healthy limb, perform at an average pace one. Lying on his back Flexion and extension knee joint 20-35 3-5 flexion inhalation, extension exhalation 2. Lying on his back Lead No. ™ to the side 30 ° -40 ° 10-25 3-5 abduction, adduction of exhalation Rest as a patient, mainly 3-5 minutes 3 Lying on his back Stop by yourself. Raising a straight leg up 20 ° 30 ° from the surface of the bed and holding it for 3-5 seconds 5-7 3-5 raising inhale, lowering exhale Active movements in a diseased limb, performed at a slow pace one. Lying on his back Stop on yourself and keeping it in this position for 3-5 seconds. 15-25 3-5 arbitrary breathing 2 Lying on his back Stop yourself and hold 15-25 3-5 arbitrary breathing

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her in this position for 3-5 seconds. 11; 1 blue movement in a sick limb, performed at a slow pace with the help of a specialist. one. Lying on your back Abduction of the leg to the side up to 50 °. When performing the exercise, the specialist’s hands are: one under the knee fossa, the other on the ankle joint. 15-30 3-5 Abduction of fleas. adduction exhale 2. Lying on his back The operated limb is bent at the knee joint, the healthy one is bent. With the bent position of the operated limb, the specialist with his hands with effort increases the angle of bending by pressing on the knee joint, to mild pain, then the limb extends and relaxes. 15-30 3-5 Arbitrary breathing Rest as a patient, mainly 3-5 minutes 3. Lying on his back Raise a straight leg up from the bed surface by 40-60 cm and perform flexion movements into extension in the knee joint. Bending angle from 70 to 90 °. When performing the exercise, specialist’s hands are: one below the knee fossa, the other on the ankle joint. 10-20 3-5 Arbitrary breathing 4. Lying on his back The legs are straight. Under the operated leg lies a roller 20-30cm high. Extension exercise in the knee joint of the operated limb and holding it for 3-5 seconds. The specialist helps the patient perform 10-20 3-5 Arbitrary breathing

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an exercise. 5. Lie on your back The legs are bent at the knee joints to 90 °. Specialist sit! next to the couch with the patient from the side of the operated limb. The specialist's hand holds the patient's foot. The patient’s task is to raise the pelvis up ΙΟΙ 5cm 10-15 3-5 Poshiggis inhale, lowering exhale 6. Lying on his back A healthy limb is bent at the knee by 90 °. The operated limb lies unbent. The specialist sits next to him on the couch with the patient from the side of the operated limb. The specialist's hand holds the patient's foot. The patient’s task is to raise the pelvis up by 10-15 cm 10-15 3-5 Raising inhale, lowering exhale 7. Lying on his back Raise a straight leg up from the bed surface by 40-60 cm. And perform flexion movements in extension in the knee joint. Bending angle from 70 to 90 °. In the flexion position, keep the foot in this position for 5-10 seconds. When performing the exercise, the specialist’s hands are: one below the knee fossa, the other on the ankle joint. 10-20 3-5 Arbitrary breathing Active exercises in a healthy and diseased limb are performed at a slow pace, under the supervision of a specialist one. Sitting on the bed Alternating flexion and extension of the legs in the knee joints. In this case, the patient himself tries to bend and unbend the operated limb without the help of a specialist 20-30 3-5 Extension inhalation, flexion exhalation

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2 Sitting ίι; ι κροκοί and Feet stand on a bench exactly parallel to each other at a distance of 15-20 cm. Alternately raising and lowering a moan up and down on fixed heels. 20-30 3-5 arbitrary breathing 3. Sitting on the bed Extension of the operated limb with the help of a healthy one. Get a healthy limb under the operated and straighten it. 10-15 3-5 Extension inhalation, flexion exhalation Active movements are performed in a liquid medium under the supervision of a specialist one. Sitting The feet are on the floor exactly parallel to each other at a distance of 15-20 cm. Alternately raising and lowering the feet up and down on fixed heels. 20-30 3-5 arbitrary breathing 2. Sitting Alternating flexion and extension of the legs in the knee joints. At the same time, try to bend the operated limb to 90 “’ 15-20 3-5 extension inhalation, flexion exhalation 2.1 Sitting Alternating flexion and extension of the legs in the knee joints. 30-40 3-5 extension inhalation, flexion exhalation 3. Sitting Both legs are relaxed and bent at an angle of 90 °. Exercise “game of football” Alternating bending and extension of the legs in the knee joints, while a healthy leg is bent, and the operated leg is bent and vice versa. 20-30 3-5 arbitrary breathing Rest as a patient, mainly 3-5 minutes 4. Sitting Simultaneous extension of the legs in the knee joints and their retention for 5-15 seconds 20-30 3-5 extension inhalation, flexion exhalation 5. Sitting Alternately lifting straight legs up. 180 ° extension angle 20-30 3-5 Raising Inhale, Lowering Exhale 6. Sitting Leaving aside a healthy leg by 20-40 ° 10-15 3-5 Abduction, adduction of exhalation

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7. Sitting Exercise bike 10-15 3-5 arbitrary breathing 8. Sitting Scissors Exercise 10-15 3-5 breathing arbitrary nine. (.'idea Alternating drawing with the straight leg of the figure eight. 10-15 3-5 arbitrary breathing 10. Sitting The legs are straight. Raising and lowering straight legs. in this case, the operated limb drops, and the healthy one rises and vice versa. 10-15 3-5 arbitrary breathing Feet at a distance of 15-20 cm. Feet parallel to each other. Hands hold the handrail. ι. Standing Toe toes 5-10 3-5 Raising inhale, lowering exhale 2. Standing Squat 15-25 " 5-10 3-5 Down inhale, up exhale 3. Standing Hands on the belt. Steps left and right 5 times one way and 5 times the other way. The feet are parallel to each other. The exercise is slow. 3-5 2-3 Arbitrary breathing 4. Standing Hands on the belt. Alternating steps to the side with a half squat at 10-20 “. Step, then half-squat, step, half-squat. Runs left and right. The feet are parallel to each other. The exercise is slow. 3-5 2-3 Arbitrary breathing 5. Standing Emphasis with one hand on the handrail. Walking back and forth while bending the legs at the knee joints. 3-5 2-3 Arbitrary breathing 6. Standing Emphasis with one hand on the handrail. Walking back to back, while raising the heel up. The exercise is slow. 3-5 2-3 Arbitrary breathing Several times a day, the patient should walk on crutches Active exercises in healthy and diseased limbs, in a standing position with two hands resting on the handrail, while performing movements, the specialist fixes the patient with his hands behind the body

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one. Standing Focus on the hands. The forest was transferred alternately to one leg, then to the other leg, the gel weight on a sore leg was 5 Js: on a healthy leg ΙΟΙ 5 sec. 10-15 3-5 Arbitrary breathing 2. Standing on a healthy foot Mahi forward sore foot angle 20 ° -35 ⁰ 10-15 2-3 forward inhale, back exhale 3. Standing on a sore foot Maxi forward healthy leg angle 20 ° -35 ⁰ 10-15 2-3 forward inhale, back exhale 4. Standing 20-25 ”Squat 10-15 2-3 Down inhale, up exhale Rest as a patient, mainly 3-5 minutes 5. Standing Emphasis with one hand on the handrail. Walking back and forth while bending the legs at the knee joints. 3-5 2-3 Arbitrary breathing 6. Standing Emphasis with one hand on the handrail. Walking back to back, while raising the heel up. The exercise is slow. 3-5 2-3 Arbitrary breathing Rest as a patient, mainly 3-5 minutes Active-passive exercises in a healthy and diseased limb FROM? with the help of a specialist, the patient sits on the bed from a prone position. The distance between the hips should be 15-20 cm. From 5-7 days, the patient sits on his own * keeping the sore leg healthy. one. Lying on his back Both legs are straight. The distance between the legs is 50 bOsm. Alternately pulling the legs together, while sliding the heel on the bed surface. Do-it-yourself specialist helps the operated limb. 10-20 3-5 Pulling in a breath, etc. exhale 2. Lying on his back Exercises "scissors". The specialist supports the operated limb 15-25 3-5 arbitrary breathing 3. Lying on your back The legs are bent at the knee joints. The distance between the feet is 20-30 cm. Alternately bringing the bent limbs to each other. 15-25 3-5 arbitrary breathing To help the patient roll onto his stomach through a healthy leg, while the specialist supports the operated leg with his hands. one. Lying on his stomach Hands along torso Alternating flexion and extension of knee joints. The specialist holds the operated limb with his hands. 15-25 3-5 Extension inhalation, flexion exhalation

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2 .A gentle on the living th 14 ki along torso Flexion and extension of the operated limb in the knee rush. and holding in the bending position for 15-20 seconds. Healthy leg is straight, The specialist holds the operated limb with his hands. 15-25 3-5 flexion inhalation, extension exhalation 3. Lying on his stomach Hands along torso The legs are straight. The distance between the legs is 3040cm. Alternately raising straight legs up from the bed surface by 1520cm. 15-25 3-5 flexion inhalation, extension exhalation 4. Sitting on the bed. Simultaneous extension of the legs in the knee joints. The specialist holds the operated limb with his hands. 15-25 3-5 Extension inhalation, flexion exhalation 5. Sitting on the bed. Both legs are relaxed and hang from the bed. Soccer game exercise. Alternating flexion and extension of the legs in the knee joints, while a healthy leg is bent, and the operated leg is bent and vice versa. 20-30 3-5 arbitrary breathing 6. Sitting on the bed. Extension of the operated limb in the knee joint, with the help of a healthy one. A healthy leg is brought under the operated leg and extends the operated leg. 15-25 3-5 Extension inhalation, flexion exhalation Rest as a patient, mainly 3-5 minutes and a light massage of the operated limb 7. Sitting on the beds. Alternating flexion and extension of the legs in the knee joints. The specialist holds the operated limb with his hands. 15-20 3-5 Extension inhalation, flexion exhalation 8. Sitting on the bed. The feet are on the bench exactly parallel to each other at a distance of 15 * 20 cm. Alternately raising and lowering the feet up and down on fixed heels. 15-25 3-5 arbitrary breathing nine. Sitting on the bed The exercise has “scissors”. Specialist supports the operated limb. 15-20 3-5 arbitrary breathing To help the patient roll over on a healthy side and put a roller between the legs. 10. Lying on a healthy limb. Flexion and extension in the ankle the joint. 15-20 3-5 arbitrary breathing Η. Lying on a healthy limb. Sock on yourself. Raise a straight leg up by 15-20cm. The specialist holds the operated limb with his hands. 15-20 3-5 arbitrary breathing

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12. Lying down 3. | (1p1> 1 st limbs. Sock on yourself. Fire straight leg back pa 15-20cm. The specialist holds the operated limb with his hands. 15-20 3-5 breathe foxes arbitrary thirteen Lie to a healthy limb. Sock on my own. Straight leg 15-20cm. forward swing. The specialist holds the operated limb with his hands. 15-20 3-5 arbitrary breathing

The fourth stage.

From 45-90 days the patient performs passive and active exercises, while active exercises are performed independently by the patient. The patient performs exercises with increasing effort (with overcoming resistance, for example, an elastic bandage, inflatable balls), with an increase in the number of repetitions, as well as in unloading positions (standing on a healthy leg, standing on two legs with the rest of the hands on the backs of chairs, etc. ), and also continues exercises in a liquid environment.

During this period, up to 90 days, the patient is recommended walking on crutches. The bending angle of the knee joint reaches from 90-110 °.

The goal is to strengthen the muscle system of the lower extremities and lumbar spine, stretching and elasticizing the ligamentous apparatus, combating muscle atrophy, stimulating metabolic processes due to weighted movements, training the cardiovascular system by walking, half-squats and performing exercises with increasing effort, increase the overall tone of the body.

No. And p. Exercises Reps Number of approaches Breathing movements Active movements in a healthy limb, perform at an average pace one. Lying on his back Flexion and extension of the knee 20-35 3-5 flexion inhalation, extension exhalation 2. Lying on his back Leaving legs to the side on ZOMO ⁰ 10-25 3-5 abduction, adduction of exhalation 3. Lying on his back Circular rotations in the ankle joint in different directions 10-25 3-5 arbitrary breathing Rest as a patient, mainly 3-5 minutes 3 Lying on his back Stop by yourself. Raising a straight leg up 20 ° 30 ° from the surface of the bed and holding it 5-1 Mace. 10-25 3-5 raising inhale, lowering exhale Active movements in a diseased limb, performed at a slow pace one. Lying on his back Stop on yourself and keeping it in this position for 3-5 seconds. 20-35 3-5 arbitrary breathing 2. Lying on his back Stop from yourself and hold the EU in this position for 3-5 seconds. 20-35 3-5 arbitrary breathing 3. Lying on his back Flexion and extension of the knee 10-25 flexion inhalation, extension exhalation Passive movements in a diseased limb are performed at a slow pace with the help of a specialist. one. Lying on his back Leaving the legs to the side 30-45 3-5 Abduction, adduction of exhalation

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up to 50". During the exercise, the specialist’s arms will accumulate ·, one floor with the knee fossa, the other on the ankle joint. 2 Lying on his back The operated limb is bent at the knee joint, the healthy one is bent. In the bent position of the operated limb, and the specialist with his hands with effort increases the angle of bending by pressing on the knee joint, to light pain, then the limb extends and relaxes. 50-45 3’5 Arbitrary breathing

Rest as a patient, mainly 3-5 minutes

3. Lying on his back Raise a straight leg up from the bed surface by 40-60 cm. And perform flexion movements in extension in the knee joint. Bending angle from 90 to 110 °. When performing the exercise, the specialist’s hands are: one below the knee fossa, the other on the ankle joint. 15-30 3-5 Arbitrary breathing 4. Lying on his back The legs are straight. Under the operated leg lies a roller 20-30cm high. Extension exercise in the knee joint of the operated limb and holding it for 3-5 seconds. The specialist helps the patient complete the exercise. 15-30 3-5 Arbitrary breathing 5. Lying on his back The legs are bent at the knee joints to 90 °. Specialist silite near on 15-30 3-5 Raising a breath, lowering a vmokh

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a couch with a patient from the side, an oleryrona limb. The specialist’s hand holds the patient’s experience. The patient’s task is to raise the pelvis up 1 ΟΙ 5cm 6. Lying on his back A healthy limb is bent at 90 “in the knee joint. The operated limb lies unbent. The specialist sits next to him on the couch with the patient from the side of the operated limb. The specialist's hand holds the patient's foot. The patient’s task is to raise the pelvis up by 10-15 cm 15-30 3-5 Raising inhale, lowering exhale 7. Lying on his back Raise a straight leg up from the bed surface by 40-60 cm. And perform flexion movements in extension in the knee joint. Bending angle from 90 to 110 °. In the flexion position, keep the foot in this position for 10-20 seconds. When performing the exercise, the specialist’s hands are: one below the knee fossa, the other on the ankle joint. 15-30 3-5 Arbitrary breathing Active exercises in healthy and diseased limbs are performed at a slow pace, under the supervision of a specialist one. Lying on his back Movement for resistance Bend the leg in the knee joint by 90 ° -110 ° Pick up an elastic bandage, with the help of a specialist, throw it on the foot, and give the patient two free ends in his hands. Bish must be pulled, patient tries 5-10 3-5 open a breath, bend an exhale

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to straighten the leg, while holding the ends of the elastic bandage with his arms. Then bend the leg η I.i. back 2. Lying on the blue Specialist treasure! pa bed under the patient's knees inflatable ball The angle of flexion in the hip joints should be 90 °. The patient’s task is to press the ball for 3-5 seconds with both feet. 5-10 3-5 arbitrary breathing 3. Lying on his back The specialist puts an inflatable ball on the bed under the patient’s knees. The angle of flexion in the hip joints should be 90 °. The patient’s task is to alternately kick the ball for 3-5 seconds. 5-10 3-5 arbitrary breathing 4. Lying on his back The specialist puts an inflatable ball on the bed under the patient’s knees. The angle of flexion in the hip joints should be 90 °. The task of the patient with both legs to try to roll the ball back to his heels and roll it back. The specialist’s hands are on the patient’s legs and slightly support the legs in the correct position. 5-10 3-5 arbitrary breathing 5. Lying on his back The specialist puts an inflatable ball on the bed under the patient’s knees. The angle of flexion in the hip joints should be 90 °. The patient's task, resting on the ball with both legs, raise the pelvis up by 10-15 cm and hold it for 3-7 5-10 3-5 arbitrary breathing

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sec The specialist holds the ball with his hands. 6. Lying on his back The specialist puts an inflatable ball on the bed under the patient’s knees. The angle of flexion in the hip joints should be 90 °. The patient's task is to simultaneously bend and unbend the ankle joints. 5-10 3-5 arbitrary breathing 7. Lying on his back The specialist puts an inflatable ball on the bed between the patient’s knees. The angle of flexion in the knee joints should be 90 ^:. The task of the patient at the same time knee joints to press on the ball. 10-15 3-5 arbitrary breathing 8. Lying on his back The specialist puts an inflatable ball on the bed between the patient’s knees. The angle of flexion in the knee joints should be 90 °. The task of the patient alternately knee joints to press on the ball. 10-15 3-5 arbitrary breathing nine Lying on his back The specialist puts an inflatable ball on the bed between the patient’s knees. The angle of flexion in the knee joints should be 90 °. The patient's task is to squeeze the ball with the knee joints and raise it from the bed surface and hold for 5-10 seconds. 10-15 3-5 Raising inhale, lowering exhale '· Sitting on the bed Alternating flexion and extension of the legs in the knee joints. In this case, the patient himself tries to bend and unbend the operated limb without the help of a specialist 30-45 3-5 Extension inhalation, flexion exhalation

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2 Sitting on the roof! The feet stood on the bench exactly parallel to each other at a distance of 15-20 cm. Alternately raising and lowering the feet up and down on fixed heels. 30-45 3-5 LYAHES PRODUCTION 3. Sitting on the bed. Extension of the operated limb with healthy weakness. Get a healthy limb under the operated and straighten it. 10-15 3-5 Extension inhalation, flexion exhalation Light relaxing massage

Specialist puts between

the knees of the patient joints should be 90 °.

The task of the patient with both legs to press the ball on the ball. Knee flexion angle

The specialist puts an inflatable ball between the patient’s knees. The angle of flexion in the knee joints should be 90 °.

The patient’s task is to alternately kick the ball for 3-5 seconds.

The specialist puts an inflatable ball under the patient’s knees. The angle of flexion in the knee joints should be 90 °. The task of the patient with both legs to try to roll the ball back to his heels and roll it back. The specialist’s hands are on the patient’s legs and slightly support the legs in the correct position.

Lightweight | Specialist puts under

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kroiggn. knees of the patient an inflatable ball. The angle of flexion in the knee joints should be 90 °. The patient's task is to simultaneously bend and unbend the ankle joints. 8. Sitting down ia beds. The specialist puts an inflatable ball between the patient’s knees. The angle of flexion in the knee joints should be 90 °. The task of the patient at the same time knee joints to press on the ball. 10-15 3-5 arbitrary breathing Light relaxing massage nine. Sitting on the bed. The specialist puts an inflatable ball between the patient’s knees. The angle of flexion in the knee joints should be 90 °. The task of the patient alternately knee joints to press on the ball. 10-15 3-5 arbitrary breathing 10. Sitting on the bed. The specialist puts an inflatable ball between the patient’s knees. The legs are straight. The patient’s task is to squeeze the ball with his feet and lift it up and hold for 5-10 seconds. 10-15 3-5 Raising inhale, lowering exhale Active movements in a liquid medium are performed under the supervision of a specialist one. Sitting The feet are on the floor exactly parallel to each other at a distance of 15-20 cm. Alternately raising and lowering the table up and down on fixed heels. 20-30 5-7 arbitrary breathing 2. Sitting Alternating flexion and extension of the legs in the knee joints. At the same time, try to bend the operated limb to 90 15-20 5-7 extension inhalation, flexion exhalation 2.1 Sitting Cross bending and 30-40 5-7 extension inhalation, flexion exhalation

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extension of yogis in the knee joints. 3. Shining Both legs are relaxed and bent at an angle of 9 (L Exercise “playing football.” Alternating bending and extension of the legs in the knee joints. With an angle, a healthy leg bends, and the operated leg bends and vice versa. 20-30 5-7 arbitrary breathing Rest as a patient, mainly 3-5 minutes 4. ('going Simultaneous extension of the legs in the knee joints and their retention for 5-15 seconds 20-30 5-7 extension inhalation, flexion exhalation ⁵ Sitting Alternately lifting straight legs up. Extension angle 180 ^e 20-30 5-7 Raising Inhale, Lowering Exhale 6. Sitting Leaving aside a healthy leg by 20-40 ° 10-15 5-7 Abduction, adduction of exhalation 7. Sitting Exercise bike 10-15 5-7 arbitrary breathing 8. Sitting Scissors Exercise 10-15 5-7 arbitrary breathing nine. Sitting Alternating drawing with the straight leg of the figure eight. 10-15 5-7 arbitrary breathing [0. Sitting The legs are straight. Raising to the lowering of straight legs, while the operated limb is lowered, and the healthy one is raised and vice versa. 10-15 5-7 arbitrary breathing Feet at a distance of 15-20 cm. Feet parallel to each other. Hands hold the handrail. one. Standing Toe toes feet 5-10 5-7 Raising inhale, lowering exhale 2. Standing Squat 15-25 " 5-10 5-7 Down inhale, up exhale 3. Standing Hands on the belt. Steps left and right 5 times one way and 5 times the other way. The feet are parallel to each other. The exercise is slow. 3-5 5-7 Arbitrary breathing 4 Standing Hands on the belt. Alternating steps to the sides with a half squat at 10-20 °. Step. then half squat one 3-5 5-7 Arbitrary breathing

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step. ι goal at 11 ρ her yes 11th. Runs left and right. The feet are parallel to each other. The exercise is slow. 5 Standing Emphasis with one hand on the handrail. Walking back and forth while bending the legs at the knee joints. 3-5 5-7 Arbitrary breathing ΰ. Standing At the time with one hand on the handrail. Walking back to back, while raising the heel up. The exercise is slow. 3-5 5-7 Arbitrary breathing Several times a day, the patient should walk on crutches. Active exercises in a healthy and diseased limb, in a standing position, the emphasis with both hands on the handrail while performing movements, the specialist fixes the patient with his hands behind the body Standing Focus on the hands. Transfer of body weight alternately on one leg, then on the other leg, body weight on a sore leg 510 sec; on a healthy leg ΙΟΙ 5 sec. 10-15 3-5 Arbitrary breathing 2. Standing on a healthy foot Mahi forward sore foot angle 20 ° -35 ° 10-15 3-5 forward inhale, back exhale 3. Standing on a sore foot Mahi forward healthy leg angle 20 ^ΰ -35 ^ΰ 10-15 3-5 forward inhale, back exhale 4 Standing Squat at 20-25 ^and 10-15 3-5 Down inhale, up exhale Rest as a patient, mainly 3-5 minutes 5. Standing Emphasis with one hand on the handrail. Walking back and forth while bending the legs at the knee joints. 5-10 2-3 Arbitrary breathing 6. Standing Emphasis with one hand on the handrail. Walking back to back, while lifting the heel up. Exercise is performed slowly. 5-10 2-3 Arbitrary breathing Rest as a patient, mainly 3-5 minutes Active-passive exercises in a healthy and diseased limb With the help of a specialist, the patient sits on the bed from a prone position. The distance between the hips should be 15-20 cm. From 5-7 days, the patient sits on his own, keeping his leg healthy.

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one Ι1οκ; ι neither, ιιιιιΐϋΐϋ Both are straight lines. The distance between the legs is 50-60cm. Alternately with half-legged feet, each other is facing one another, with the heel sliding along the SEARCH bed. Do-it-yourself specialist helps the operated limb. 10-20 5-7 G1oL1 take a deep breath. I.K. exhale 2. Lying on his back Exercises "scissors". The specialist supports the operated κοι ssc1 justice. 15-25 5-7 arbitrary breathing 3. Lsj; '| pa back The legs are bent at the knee joints. The distance between the feet is 20-30 cm. Alternately bringing the bent limbs to each other. 15-25 5-7 arbitrary breathing To help the patient roll onto his stomach through a healthy note, while the specialist supports the operated leg with his hands. one. Lying on his stomach Hands along torso Alternating flexion and extension of the legs in the knee joints. The specialist holds the operated limb with his hands. 15-25 5-7 Extension inhalation, flexion exhalation 2. Lying on his stomach Hands along torso Flexion and extension of the operated limb in the knee joint, and holding in the flexion position for 15-20 seconds. Healthy leg is straight. The specialist holds the operated limb with his hands. 15-25 5-7 flexion inhalation, extension exhalation 3. Lying on his stomach Hands along torso The legs are straight. The distance between the legs is 3040cm. Alternately raising straight legs up from the bed surface by 1520cm. 15-25 5-7 flexion inhalation, extension exhalation 4. Squad on the beds. Simultaneous extension of the legs in the knee joints. The specialist holds the operated limb with his own hands. 15-25 5-7 Extension inhalation, flexion exhalation 5. Sitting on the bed. Both legs are relaxed and hang from the bed. Soccer game exercise. Alternating flexion and extension of the legs in the knee joints, while a healthy leg is bent, and the operated leg is bent and vice versa. 20-30 5-7 arbitrary breathing 6. 1 ι Sitting on the bed. Extension of the operated limb in the knee joint, with the help of a healthy one. A healthy leg is brought under the operated yoga and extends the operated. 15-25 5-7 Extension inhalation, flexion exhalation

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Дыхι breathing on the patient’s condition, mainly 3-5 minutes n light massage of the operated limb

7. Sitting neither the beds. Alternating flexion and extension of the legs in the knee joints. The operated final! (> you hold onto! do it yourself! 15-20 5-7 Extension inhalation, flexion exhalation 8. Sitting on the beds. The feet are on the bench exactly parallel to each other at a distance of 15-20 cm. Alternately raising and lowering the feet up and down on fixed heels. 15-25 5-7 arbitrary breathing nine. Sitting on the bed Exercises "scissors". The specialist supports the operated limb. 15-20 5-7 arbitrary breathing To help the patient roll over on a healthy side and put a roller between the legs. 10. Lying on a healthy limb. Flexion and extension in the ankle joint. 15-20 5-7 arbitrary breathing eleven. Lying on a healthy limb. Sock on yourself. Raise a straight leg up by 15-20cm. The specialist holds the operated limb with his hands. 15-20 5-7 arbitrary breathing 12. Lying on a healthy limb. Sock on yourself. Take the straight leg back 15-20cm. The specialist holds the operated limb with his hands. 15-20 5-7 arbitrary breathing thirteen. Lying on a healthy limb. Sock on my own. Straight leg 15-20cm max forward. The specialist holds the operated limb with his hands. 15-20 5-7 arbitrary breathing

The fifth stage.

From 91-180 days, the patient performs active exercises with increased load on the lower extremities by increasing the number of repetitions and approaches, taking into account the individual condition of the patient, his associated diseases. The patient performs the exercises independently and under the supervision of a specialist.

After 90 days, the patient is transferred to a cane.

The angle of flexion of the knee joint reaches 110 ° or more.

The sixth stage.

From the 181st day and onwards throughout life, a complex of active exercises is carried out in the supine, abdominal and lateral positions, as well as sitting, standing, exercises in a liquid medium are carried out according to an individual program designed for the patient. The patient performs the exercises independently and under the supervision of a specialist.

As a result of the implementation of the rehabilitation program, the amplitude of movements in the knee joint during flexion reaches 110 ° and more, during extension - 180 °, which corresponds to the norm.

Examples of the method.

Patient N., 33 years old. Rheumatoid arthritis, bilateral gonarthrosis of the knee joints. An operation on endoprosthetics of the right knee joint was performed in 1999, and of the left knee joint in 2000.

In the preoperative period, psychological and informational preparation of the patient for the upcoming operation was conducted, the shown and contraindicated behavior in the early postoperative and distant periods were studied.

After the operation of endoprosthetics of the right and then the left knee joint, the patient carried out a rehabilitation program to restore the motor activity of the operated joint, which was carried out in 6 stages. On the 1st day after the operation, with the help of a specialist, the patient was put on his feet by the bed for 5-10 seconds, on the 2nd day the patient began to walk with the help of a specialist on “walkers”. Passive, passively active and active exercises were performed with the help of a specialist and under the supervision of a specialist in the initial positions: lying on his back, on his healthy side, on his stomach, sitting, standing and in a liquid environment in a healthy and operated limb.

From the 5th day to 3 months, the patient walked on crutches, from the 6th day the exercises were performed with the help of a specialist, under the supervision of a specialist, independently, adhering to the above recovery program.

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After 3 months, the patient compiled an individual program for the implementation of therapeutic exercises.

After 3 months, the patient began to walk without additional support, does not limp, has good muscle tone in the lower extremities, returned to a full life, went to work. He is currently working, is implementing an individual program of therapeutic exercises, according to x-ray studies of the operated joint, the condition of the endoprostheses in the bone tissue is stable.

Patient T., 54 years old. Gonarthrosis with deformation in the left knee joint. An operation on endoprosthetics of the left knee joint was performed in 2005.

In the preoperative period, psychological and informational preparation of the patient for the upcoming operation was conducted, the shown and contraindicated behavior in the early postoperative and distant periods were studied.

After the operation of endoprosthetics of the left knee joint, the patient underwent a rehabilitation program to restore the motor activity of the operated joint, which was carried out in 6 stages. On the 1st day after the operation, with the help of a specialist, the patient was put on his feet by the bed for 5-10 seconds, on the 2nd day the patient began to walk with the help of a specialist on “walkers”. Passive, passively active and active exercises were performed with the help of a specialist and under the supervision of a specialist in the initial positions: lying on his back, on his healthy side, on his stomach, sitting, standing and in a liquid environment in a healthy and operated limb.

From the 5th day to 3 months the patient walked on crutches, from the 6th day the exercises were performed with the help of a specialist, under the supervision of a specialist, independently, adhering to the above recovery program.

After 3 months, the patient compiled an individual program for the implementation of therapeutic exercises.

After 3 months, the patient began to walk without additional support, does not limp, has good muscle tone in the lower extremities, and returned to a full life. He is currently working, is implementing an individual program of therapeutic exercises, according to x-ray studies of the operated joint, the state of the endoprosthesis in the bone tissue is stable.

Patient K., 63 years old. Polyosteoarthrosis, gonarthrosis of the right knee joint. Right knee replacement surgery was performed in 2002.

In the preoperative period, psychological and informational preparation of the patient for the upcoming operation was conducted, the shown and contraindicated behavior in the early postoperative and distant periods were studied.

After the operation of endoprosthetics of the right joint, the patient carried out a rehabilitation program to restore the motor activity of the operated joint, which was carried out in 6 stages. On the 1st day after the operation, with the help of a specialist, the patient was put on his feet by the bed for 5-10 seconds, on the 2nd day the patient began to walk with the help of a specialist on “walkers”. Passive, passively active and active exercises were performed with the help of a specialist and under the supervision of a specialist in the initial positions: lying on his back, on his healthy side, on his stomach, sitting, standing and in a liquid environment in a healthy and operated limb.

From the 5th day to 3 months, the patient walked on crutches, from the 6th day the exercises were performed with the help of a specialist, under the supervision of a specialist, independently, adhering to the above recovery program.

After 3 months, the patient compiled an individual program for the implementation of therapeutic exercises.

After 3 months, the patient began to walk without additional support, does not limp, has good muscle tone in the lower extremities, and returned to a full life. He is currently working, is implementing an individual program of therapeutic exercises, according to x-ray studies of the operated joint, the condition of the endoprostheses in the bone tissue is stable.

For a person skilled in the art it is clear that the above description does not exhaust all the possible exercises implemented within the framework of the main idea of the invention.

Claims (8)

CLAIM 1. A method of rehabilitation of patients after hip and knee joint arthroplasty, including the implementation of therapeutic exercises, the complex of which contains combined breathing, therapeutic exercises and relaxation exercises, characterized in that a rehabilitation program consisting of therapeutic exercises aimed at restoring physical activity in the hip and knee joints, performed using the principles of multi-stage, 6 stages, divided by time intervals, subject to the conditions of I am a set of exercises, the rules of behavior of the patient in the early postoperative period and the rules of behavior of the patient in everyday life in the remote period. - 49 010788 2. The method according to claim 1, characterized in that the exercise period begins with the first stage, which lasts from 1 to 3 days after the operation, where the patient with the help of a specialist is put on the legs by the bed for 3-10 s to prevent the formation of thrombophlebitis, and from the 3rd day under control, they put on “walkers”, then they perform a series of lightweight passive and active exercises in the sore and healthy limbs with the help of a specialist and under the supervision of a specialist with a duration of classes of 5-15 minutes. 3. The method according to claim 1, characterized in that during the period of the exercises of the second stage, which lasts from 4 to 15 days after hip joint arthroplasty, the patient performs passive, passive-active, active exercises in lightweight starting positions: supine, sitting with the help of a specialist, under his control, and from 8-10 days after the operation, exercises are performed mainly in a liquid medium, while from 5-6 days the patient actively begins to walk on crutches, after knee joint arthroplasty the patient performs passive, pa active, active exercises in lightweight starting positions: lying on your back, lying on your stomach and healthy side, sitting, standing in a liquid medium with the help of a specialist, under the supervision of a specialist, and from 7-8 days after the operation active exercises are performed mainly in liquid environment in the sitting and standing positions under the control of a specialist, and passive-active exercises are performed lying on the stomach and lying on the healthy side, from 5-6 days the patient actively begins to walk on crutches, 14-15 days after the operation the patient is swimming under the control of a specialist ialista with the duration of employment 25-30 minutes. 4. The method according to claim 1, characterized in that when performing exercises in the third stage, which lasts from 16 to 45 days after the operation, the patient performs passive and active exercises, passive-active exercises, lying on his back, sitting, standing with complication, the introduction of a new set of exercises, conducting an additional set of exercises in a liquid medium with the help of a specialist, under the supervision of a specialist with a duration of 25-30 minutes 5. The method according to claim 1, characterized in that when performing exercises in the fourth stage, which lasts from 46 to 90 days after surgery, the patient performs passive, active, passive-active exercises, lying on his back, sitting, standing, while active exercises are performed by the patient independently, as well as with the use of additional items: inflatable balls, elastic bandage, with an increase in the number of repetitions, as well as standing in the unloading positions, standing on a healthy leg, standing on two legs with the support of the arms on the backs of chairs, etc. with duration classes 25-30 minutes 6. The method according to claim 1, characterized in that when performing exercises in the fifth stage, continuing from 91 to 180 days after surgery, the patient performs active exercises, increasing the load on the lower limbs by increasing the number of repetitions and including new exercises in the prone position stomach, on a healthy side, sitting and standing in a liquid medium. Exercises are performed independently and under the supervision of a specialist, taking into account the individual health of the patient, his accompanying diseases. After 90 days, the patient goes to the cane, you can connect swimming with a duration of 25-45 minutes. 7. The method according to claim 1, characterized in that the exercises at the sixth stage, which lasts from 181 days after the operation and further, throughout the life of the patient performs independently and under the supervision of a specialist, active exercises in the supine, abdominal, flank positions, sitting and standing in a liquid environment. The complex of exercises is developed individually for each patient with a duration of training of 30-50 minutes. 8. The method according to PP.1 and 3, characterized in that after endoprosthetics of the knee joints in the second stage, on the 7-8th day, it is possible to perform recovery exercises in a liquid medium in the sitting and standing positions and passive-active exercises in the prone position and lying on a healthy side, and on the 14th day after the operation swimming under the supervision of a specialist is recommended.