From the Research
Yes, patients are usually allowed to bear weight after a revision Total Knee Arthroplasty (TKA), typically with weight-bearing as tolerated (WBAT) beginning on the first postoperative day. Most surgeons permit immediate weight-bearing with assistive devices such as a walker or crutches initially, progressing to a cane as strength and balance improve. This approach differs from primary TKA only in that patients may require assistive devices for a longer period, often 4-6 weeks versus 2-3 weeks for primary procedures. The specific weight-bearing protocol may be modified based on the extent of bone loss, implant fixation method, and whether structural grafts or augments were used. For complex revisions with significant bone reconstruction or when using structural allografts, the surgeon might restrict weight-bearing to partial or toe-touch for 6-8 weeks to allow for adequate healing and implant integration. Early weight-bearing is generally encouraged because it helps maintain muscle strength, prevents bone demineralization, improves proprioception, and enhances overall functional recovery. It also reduces the risk of complications associated with prolonged immobility such as deep vein thrombosis and pulmonary embolism, as seen in studies such as 1. However, the most recent and highest quality study, 2, suggests that excessive loading did not seem to influence the number and severity of postoperative complications, which supports the practice of early weight-bearing. Additionally, rehabilitation techniques, including strengthening and intense functional exercises, as discussed in 3, can be beneficial for patients after TKA, further supporting the importance of early weight-bearing and mobilization. Therefore, the approach to weight-bearing after revision TKA should be individualized based on the patient's specific condition and the surgeon's preference, with a focus on minimizing complications and optimizing functional recovery. Some key points to consider when determining the weight-bearing protocol include:
- The extent of bone loss and implant fixation method
- The use of structural grafts or augments
- The patient's overall health and mobility status
- The risk of complications such as deep vein thrombosis and pulmonary embolism, as discussed in 1
- The potential benefits of early weight-bearing and mobilization, as supported by 3 and 2.