How soon should a patient with a successful total knee arthroplasty do away with any form of walking aid, even when there is no pain any longer.?
Hi, as a rule follow the advice of the operating surgeon. In general uncemented implants need bony integration to happen to gain long term stability and so will require periods of protected weight bearing or non weight bearing up to 6 weeks.
Hi, with cemented TKA no walking aids are needed when the pain is tolerable and quadriceps strenght is sufficient to lock the knee in extension. Saying that, the majority of patients can walk without walking aids after a week of TKA.
Best regards, Samo
6 weeks is a reasonable frist. It may take even longer in patients with preoperatve joint contractures which is often the case. Programmed exercices are essential. Quickstep to throwing away of aids is possible but not necessary.
normally in uncemented cases, a gradually increasing weightbearing is necessary for 3 months; meaning then only leaving the sticks. In cemented arthroplasty an immidiate weightbearing is possible.
If the patient walks either with pain or due to insufficient muscles or insufficient physiotherapy still limps, he should wear 2 or at least 1 waking aid. Otherwise other joints, vertebrae and/or implant will suffer.
There is no and cannot a strict protocol, it needs to be tailor made according to the patients. The following facts needs to be considered before taking the patient "off" from walking aid after TKA.
Preop:
1. What is the age of the patient?
2. What is the walking ability of the patient? Was using any support?
3. What is the status of Neurological functions ? Higher functions - ability to understand exercise / walking balance / giddiness etc
4. Preoperative deformity of the affected knee and other joints of the ipsilateral and contra lateral lower limb.
Intraop:
1. Cemented or uncemented
2. Introp stability achieved
3. Bilateral or Unilateral TKA
4. TKA only or TKA + THA
Postop:
1. Post op pain
2. The coordination between physiotherapist and surgeon
3. Home environment - conducive for good walk/free walk? / care takers available?
I agree entirely with the considerations of Dr. Satish. I am sure that colleagues that do not force a quick removal of the walking aids sleep better.
Cemented arthroplasty can do an immediate pain relief, also an immediate weight bearing is possible without supportive aid.
I fully agree with Drs TANCHEV and SATISH on that subject... On my opinion, and except for uncemented implants that follow specific biologic rules and scheduled radiologic controls, the time during which walking aids are necessary is usually related to the results of the post-operative rehabilitation. These results are themselves related to the initial physiological capabilities - in direct relationship with the age - and to the pain relief... So I don't have specific rules for it and on my experience, younger and healthy patients heal really very fast and therefore older ones need further treatments and help. I usually let them manage their own personal and socio-professional reinsertion following their inner feelings and their ability to properly lock their knee and move it up to a satisfying ROM. The average time is about 3-6 weeks... Despite all this ans as previously said, preoperative contractures and per-operative instability or insufficient ROM should lead to closer surveys and advices..
Best regards to you all!
Hi as far as uncemented arthroplasty after 6 week patient can be mobilised without support
there is no rule. if the patient is safe without any aids and is pain free then its hard to justify using aids other than to warn others.
On my humble opinion, three factors are necessary (except for un cemented that are really specific). It's essential to reach a low level of pain during full weight bearing, to have a sufficient ROM and upon all this to restore a full vast us medialis function to be able to lock the knee for walk. So all these depend on the patient' capabilities and wills for a fast and efficient rehabilitation.
Best regards
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