Incorporation of bone into the components of the non-cemented arthroplasty takes time, and it is difficult to know when the incorporation is sufficient enough to withstand full load.
I start toe touching on day 1. At 6 weeks I give partial weight bearing. At 3 months I allow full weight bearing.
I switched almost exclusively to non cemented hips for osteoarthrits about 15 years ago. Since then I have allowed weight bearing as tolerated from day of surgery. I have done a few revisions for septic loosening, poly wear ( surgery before hightly crosslinked poly was available) and instability related to component positioning. No revisions for aseptic loosening.
Thanks Greg for sharing the information. Can you please share as to how the patients usually tolerate weight bearing in the initial days after the surgery.
Please also tell whether you are using just press fit on the acetabular side or you use some additional screws.
Regards!
I usually allow my patients to bear full weight, next day after the surgery. Depending upon their pain tolerance...
Greg, no revisions for aseptic loosening is a very optimistic result. Congratulations !
In 10-years average follow-up for cementless THR we have 8% revisions, incl. aseptic loosenig. I find this percentage realistic. Our postoperative tactics involves early ambulation with partial weight bearing immediately after surgery and full weight bearing after 2 months.
In a sistematic review, Hol et al (2010) suggested weight bearing as tolerated from day 1 of surgery after cementless THR. In fact, there is no strong evidence showing that in necessary to avoid full weight bearing after this procedure. In my center we have not had failures with this procedure.
Dr. Baldon, I do not know what model of cementless THR you use. Anyway, we have the observation that early full weight bearing causes thigh pain in some patients. Usually, it subsides in the following weeks. Logically thinking, the interface needs some time for osteointegration between cementless stem and bone canal surface. This postoperative tactics concerns more the femoral component than the acetabular one because of the sliding forces in the femoral canal.
Dr Tanchev, could you mention any strong reference supporting your point of view or this is only based on your clnical experience?
At present this point of view is based on my clinical experience. In the past we used a particular "novel" cemetless stem which caused over 90 % thigh pain and we had to abandon it. However, my team is working on a prospective study focused on the thigh pain after cementless THR and we are going to publish it when it goes to end. You may check the literature. This problem do exist in some patients.
In my experience and of several other physical therapists who follow a specific rehabilitation program without overloading the soft tissues around the hip at the first 6 weeks, we have never had serious problems and complaints about it. Moreover as you said there is no evidence against early weigth bearing after this procedure.
I have about 15 years experience with uncemented hip prosthesis. Initially we allowed for even partial weight bearing after 6 weeks. This period gradually shortened to even 0 days, means full weight bearing as tolerated as I do currently. Unfortunately I observed in several cases stem subsidence after several weeks of follow-up, but it was painless. On the other hand in about 1% of cases a peri-hip joint pain is observed even after several weeks after surgery but without any radiological problems.
I think that in 95% of uncemented THR a full as tolerated weight bearing is possible, but in 5% of cases it should be delayed. Everything depends from intraoperative situation. If bone quality is proper and implant fixation also firm, then instant full weight bearing is allowed but in some cases it is not
Dear Dr. Kaczmarek, our opinions and experiences are converging. I would never let a patient with poor quality of bone to start full weight bearing immediately after the operation. It should be decided individually from patient to patient. In osteoporotic patients I prefer cemented THR. Unfortunately, we do not know what would be the biologic response of the given patient. This is still the weak side of our practice.
It depends from bone quality, implant fixation, hip muscle strength and body mass index.
It varies from weight bearing as tolerated to full weight bearing.
Our 10 -year experience on early weight bearing did not show any problems with early weight bearing (Day 1)
However for those patients whose proximal femur were wired following fractures we delayed weight bearing for 6 weeks.Our choice of implants were mainly Depuy and Biomet
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