Weight Bearing After Knee Replacement
Yes, patients can and should bear full weight immediately after total knee replacement surgery, starting on the first postoperative day, as tolerated. This approach is safe, reduces hospital length of stay, and improves both pain and functional outcomes compared to delayed mobilization 1.
Immediate Postoperative Weight Bearing Protocol
Full weight-bearing as tolerated is recommended from day one after total knee replacement 1, 2. The American Academy of Orthopaedic Surgeons strongly supports immediate postoperative mobilization, with robust evidence demonstrating superior outcomes 1.
Key Implementation Points:
- Start rehabilitation on the day of surgery with immediate mobilization to reduce hospital length of stay and improve pain and function 1
- Allow full weight-bearing from the first postoperative day in all patients 2
- Patients may use assistive devices (crutches, walker) as needed for comfort and safety during the initial recovery period, but weight-bearing itself should not be restricted 1
What NOT to Do
Do not use knee immobilizers after total knee replacement 1. The American Academy of Orthopaedic Surgeons recommends strongly against immobilizers, as they provide no benefit for pain control, functional recovery, range of motion, or complication rates, and may actually impede rehabilitation progress 1.
Avoid continuous passive motion (CPM) machines 1. These devices do not improve outcomes and provide no clinically important effects on range of motion, pain, function, or quality of life 1.
Early Rehabilitation Components
First Two Weeks:
- Initiate immediate knee mobilization within the first week to improve range of motion and reduce pain 3
- Begin isometric quadriceps exercises including static quadriceps contractions and straight leg raises during the first 2 postoperative weeks for faster recovery of knee range of motion 3
- Apply cryotherapy immediately after surgery to reduce knee pain and swelling 3
- Consider neuromuscular electrostimulation (NMES) for the initial 6-8 weeks to re-educate voluntary quadriceps contraction 3
First Two Months:
Start a supervised exercise program during the first 2 months, which strongly improves physical function and reduces pain 1. Active range of motion exercises, such as knee flexion and extension, should be started immediately 1.
Critical Pitfalls to Avoid
The most common error is delaying mobilization or restricting weight-bearing unnecessarily 1. Early mobilization is critical to prevent stiffness and optimize outcomes 3, 1.
Another major pitfall is using immobilizers or CPM machines, which provide no benefit and may delay recovery 1.
Expected Recovery Timeline
Patients experience substantial pain relief within 3 months after total knee replacement, which is an important factor for evaluation of muscle strength and functional recovery 2. Progressive increases in muscle strength occur over the first 6 months, with the most pronounced improvements in the operated leg 2.