Efficacy of Post-operative Partial Weight-bearing After Total Knee Arthroplasty - a Prospective Observational Trial

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2023 Mar 25

PMID 36964233

Authors

Philip Mark Anderson

Tizian Heinz

Elena Scholmann

Annette Eidmann

Jorg Arnholdt

Maximilian Rudert

Boris Michael Holzapfel

Ioannis Stratos

Affiliations

Soon will be listed here.

Abstract

Purpose: There is little evidence proving the concept of partial weight-bearing to be efficient and feasible. Using insole pressure measurement systems, this study aimed to explore the compliance to prescribed weight-bearing restrictions after total knee arthroplasty (TKA).

Methods: 50 patients after TKA were recruited in a prospective manner. They were advised to limit weight-bearing of the affected limb to 200 N. True load was measured via insole force-sensors on day one after surgery (M1) and before discharge (M2). Compliance to the rehabilitation protocol was the primary outcome parameter.

Results: At M1 and M2 compliance to the rehabilitation protocol was 0% und 2%, respectively. 84% (M1) and 90% (M2) of patients overloaded the affected limb during every step. The affected limb was loaded with 50% ± 14% (M1) and 57% ± 17% (M2) of body weight. Patients older than 65 loaded the affected limb on average 17% (M1) and 34% (M2) more than their younger counterparts did. This difference was even more pronounced when walking stairs up (49% increase on average) and down (53% increase on average).

Conclusion: Surgeons must take into consideration that the ability to maintain partial weight-bearing after TKA is highly dependent on the age of the patient and the achievable load reduction is determined by the patient's body weight.

References

Kammerlander C, Pfeufer D, Lisitano L, Mehaffey S, Bocker W, Neuerburg C . Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions. J Bone Joint Surg Am. 2018; 100(11):936-941. DOI: 10.2106/JBJS.17.01222. View

Owens J, Rauzi M, Kittelson A, Graber J, Bade M, Johnson J . How New Technology Is Improving Physical Therapy. Curr Rev Musculoskelet Med. 2020; 13(2):200-211. PMC: 7174486. DOI: 10.1007/s12178-020-09610-6. View

Loiret I, Villa C, Dauriac B, Bonnet X, Martinet N, Paysant J . Are wearable insoles a validated tool for quantifying transfemoral amputee gait asymmetry?. Prosthet Orthot Int. 2019; 43(5):492-499. DOI: 10.1177/0309364619865814. View

Seiberl W, Jensen E, Merker J, Leitel M, Schwirtz A . Accuracy and precision of loadsol insole force-sensors for the quantification of ground reaction force-based biomechanical running parameters. Eur J Sport Sci. 2018; 18(8):1100-1109. DOI: 10.1080/17461391.2018.1477993. View

Renner K, Williams D, Queen R . The Reliability and Validity of the Loadsol under Various Walking and Running Conditions. Sensors (Basel). 2019; 19(2). PMC: 6359506. DOI: 10.3390/s19020265. View

Westerman R, Hull P, Hendry R, Cooper J . The physiological cost of restricted weight bearing. Injury. 2008; 39(7):725-7. DOI: 10.1016/j.injury.2007.11.007. View

Pfeufer D, Zeller A, Mehaffey S, Bocker W, Kammerlander C, Neuerburg C . Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg. 2019; 139(9):1253-1259. DOI: 10.1007/s00402-019-03193-9. View

Hershko E, Tauber C, Carmeli E . Biofeedback versus physiotherapy in patients with partial weight-bearing. Am J Orthop (Belle Mead NJ). 2008; 37(5):E92-6. View

Tveit M, Karrholm J . Low effectiveness of prescribed partial weight bearing. Continuous recording of vertical loads using a new pressure-sensitive insole. J Rehabil Med. 2001; 33(1):42-6. DOI: 10.1080/165019701300006533. View

10.

Heo S, Harris I, Naylor J, Lewin A . Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry. BMC Musculoskelet Disord. 2020; 21(1):602. PMC: 7488141. DOI: 10.1186/s12891-020-03612-8. View

11.

Winther S, Foss O, Wik T, Davis S, Engdal M, Jessen V . 1-year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track. Acta Orthop. 2014; 86(1):78-85. PMC: 4366654. DOI: 10.3109/17453674.2014.957089. View