After bilateral total knee arthroplasty, how many days postoperatively can the patient begin ambulating with a walker or crutches?

Ambulation After Bilateral Total Knee Arthroplasty

Patients should begin walking on the day of surgery (postoperative day 0) after bilateral total knee arthroplasty. 1

Evidence-Based Timeline for Mobilization

Day of Surgery (Postoperative Day 0)

• Strong evidence from the American Academy of Orthopaedic Surgeons supports initiating rehabilitation on the day of surgery, which reduces hospital length of stay and improves both pain and functional outcomes compared to waiting until postoperative day 1. 1
• Full weight-bearing with a walker or crutches should be initiated immediately on the day of surgery, provided the patient demonstrates a correct gait pattern without pain, effusion, or increased temperature. 1
• Research demonstrates that early mobilization within 24 hours dramatically reduces the risk of deep vein thrombosis by 30-fold compared to delayed mobilization. 2

Prerequisites for Safe Ambulation

Weight-bearing should only proceed when the following criteria are met:

• Correct gait pattern is achieved (with assistive device as needed). 1
• No pain during or immediately after walking. 1
• No joint effusion or swelling. 1
• No increase in temperature at the surgical site. 1

Bilateral vs. Unilateral Considerations

• Limited evidence supports performing simultaneous bilateral TKA in patients younger than 70 years or with American Society of Anesthesiologists status 1-2, as there is no increased complication rate in this population. 1
• Case reports demonstrate that motivated patients can successfully ambulate 100 feet with a rolling walker under supervision by hospital discharge (typically postoperative day 3) following bilateral procedures. 3

Structured Rehabilitation Protocol

First 48 Hours

• Twice-daily physical therapy sessions should be implemented starting on the day of surgery. 1
• Supervised exercise programs during the first 2 months after TKA provide strong evidence for improved physical function and moderate evidence for decreased pain. 1
• Isometric quadriceps exercises should begin in the first postoperative week when pain-free to reactivate the quadriceps muscles. 1

Week 1-2

• Patients typically progress from walker to independent ambulation with assistive devices during this period. 1
• Closed kinetic chain exercises can be safely performed from week 2 postoperative. 1

Common Pitfalls to Avoid

• Do not delay mobilization beyond postoperative day 0 unless there are specific medical contraindications, as this significantly increases thromboembolism risk. 2
• Do not use continuous passive motion devices, as strong evidence shows they do not improve outcomes after knee arthroplasty. 1
• Avoid cryotherapy devices for routine use, as moderate evidence demonstrates they do not improve outcomes. 1
• Ensure adequate pain control (preferably with regional anesthesia such as adductor canal blocks) to facilitate early mobilization without excessive opioid use. 1

Discharge Planning

• Most patients are discharged by postoperative day 3 with enrollment in outpatient physical therapy programs 3 days per week. 1
• By 3 months postoperatively, patients typically ambulate independently without assistive devices with knee range of motion 0° to 120°. 1