The ABC-X model is a systematic intervention approach based on stress source analysis and adaptation theory. It emphasizes the dynamic interaction between stressors (A), coping resources (B), cognitive appraisal (C), and crisis outcomes (X). By systematically assessing patients' psychosocial stress, integrating family and social support resources, and optimizing disease cognition, it helps patients and their families alleviate psychological pressure and cope with disease challenges. This study aims to explore the impact of nursing interventions based on the ABC-X model on coping styles and family functioning in patients after total knee arthroplasty.

Total Knee Arthroplasty (TKA) is primarily indicated for patients with knee joint diseases that are unresponsive to conservative treatment and significantly impair daily life and work, such as osteoarthritis, rheumatoid arthritis, traumatic arthritis, osteonecrosis, or other inflammatory joint conditions. It is one of the widely used and well-established surgical procedures in the field of orthopedics. This surgery can effectively alleviate pain, correct joint deformities, and restore joint function. However, TKA may still be associated with various postoperative complications. Coupled with the prolonged off-hospital rehabilitation period, patients often exhibit insufficient compliance and limited coping strategies, which can adversely affect their postoperative recovery outcomes. Current routine nursing care primarily focuses on consolidating surgical outcomes, preventing complications, and promoting functional recovery. While it helps improve patients' daily activity levels and facilitates postoperative rehabilitation, it lacks systematic intervention in addressing patients' psychological stress, family support, and the integration of social resources. Moreover, patients often experience varying degrees of impaired self-care ability in the short term after surgery, necessitating reliance on family members for daily assistance. Therefore, when patients transition from hospital to family and social life, providing them with a professional and multifaceted nursing model is crucial, as it directly influences the speed and quality of their recovery.

Inclusion Criteria:

1. Meet the diagnostic criteria for knee osteoarthritis as outlined in the Guidelines for Diagnosis and Treatment of Osteoarthritis (2018 Edition)[6], with confirmation by imaging examination;
2. Age 30-65 years;
3. Meet the surgical indications of our hospital and be a first-time candidate for unilateral TKA;
4. Normal neurological and cognitive function, with stable vital signs;
5. Family members have signed the informed consent form.

Exclusion Criteria:

1. Presence of lower limb movement impairments;
2. Accompanied by severe complications;
3. Infectious diseases or severe immune system disorders;
4. Other acute and critical illnesses;
5. History or presence of mental dysfunction;
6. Language or communication disorders.

A total of 117 patients who underwent TKA for knee osteoarthritis from July 2025 to July 2026 were selected as the study subjects.