The Vital Role of Early Weight Bearing post Orthopaedic Surgery

As physiotherapists, we often witness the remarkable outcomes following orthopaedic surgery. From joint replacements to fracture repairs, these procedures have transformed countless lives. While surgical techniques continue to evolve, the importance of early weight bearing following orthopaedic surgeries, once structures have healed, cannot be emphasised enough. In this blog, I will explore the significance of early weight bearing, discuss exercise suggestions to help facilitate this and address the apprehension that clients may experience during this process.

To comprehend the rationale behind early weight bearing, it’s essential to understand the healing process. After an orthopaedic surgery, the body initiates a cascade of events to repair the damaged structures. Initially, the surgical site undergoes an inflammatory response, followed by the proliferation of new tissue and remodelling. Bone fractures consolidate and become stronger, while repaired ligaments and tendons gradually regain their strength.

The Benefits of Early Weight Bearing:

In the past, prolonged immobilisation was considered the standard protocol following orthopaedic surgeries. However, studies and clinical experience have since shown that early weight bearing, once the structures have healed, offers numerous benefits for clients. It promotes faster recovery, reduces muscle atrophy, improves joint stability and accelerates functional restoration.

Let’s unpack some of these benefits more:

Improved Bone Healing

Bone healing relies on mechanical stress to stimulate osteoblast activity, the cells responsible for bone formation. Early weight bearing facilitates this process by subjecting the bone to controlled loads. This controlled stress enhances bone density, accelerates callus formation, and promotes overall bone healing. However, it is crucial to follow specific weight-bearing guidelines if there are any enforced to avoid excessive stress that could impede the healing process.

Enhanced Muscle Strength

Early weight bearing encourages muscle activation and strength development. Muscle atrophy can occur after two weeks of being non weight bearing through a joint. Hence, as soon as restrictions are removed, we want to try to start activating and strengthening these muscles immediately. As the individual gradually puts weight on the affected limb, the surrounding muscles are engaged, leading to muscle hypertrophy and improved neuromuscular control. Strengthening the muscles around the surgical site helps stabilise the joint, reducing the risk of reinjury and improving overall functional outcomes.

Joint Stability and Proprioception

Early weight bearing aids in restoring joint stability and proprioception. The controlled loading provides sensory feedback to the joint, improving its position sense and awareness. This proprioceptive feedback is vital for regaining balance, coordination, and joint control, allowing clients to perform daily activities with confidence.

Faster Return to Function

Encouraging early weight bearing enables individuals to regain functional independence faster. By gradually reintroducing weight-bearing activities, individuals improve their ability to walk, their gait patterns and other weight-bearing tasks such as walking up or down stairs. This accelerated return to function not only improves the patient’s quality of life but also reduces the prolonged financial strain of requiring extended physiotherapy rehab consultations.

Fear Avoidance and Apprehension

Despite the benefits of early weight bearing, individual may experience fear avoidance and apprehension during the rehabilitation process. Understandably, concerns about re-injury or pain can hinder their progress. This is where the role of physiotherapy becomes crucial. Providing reassurance, education and guidance to address the individuals fears and ensure a smooth transition to early weight bearing. It is common for clients to be apprehensive to load bear through the operated leg, however the risks of prolonging this should be clearly outlined. Goal setting with clients can be helpful to increase adherence and motivation to comply with gradual load bearing. Clear communication regarding the benefits of early weight bearing and, when done safely, is beneficial to their road to recovery.

Examples of exercises:

Gradual exposure to increased loads becomes a key focus at this stage of the rehabilitation post operatively. The physiotherapist should provide modifications to the program when regressions or progressions are required.

Here are some exercise suggestions to facilitate early weight bearing after hip and ankle surgeries:

Hip Surgery:

a. Seated Banded Abductions: Sitting on a chair, place a resistance band above your knees and take your knees out to side away from your body. Hold for 3 seconds then slowly bring your knees back together.

b. Quad Co-contractions: While lying down with your leg straight, tighten your thigh muscles and hold for 3 seconds.

Ankle Surgery:

a. Alphabets: Perform ankle alphabets to improve the range of motion through your ankle joints.

b. Seated calf Raises: While sitting on a chair, place your feet flat on the floor and lift your heels off the ground.

Early weight bearing, once structures have healed, plays a vital role in orthopaedic surgery recovery. It can improve bone consolidation, enhance muscle strength, restore joint stability, and result in a faster return to function. Despite initial fears and apprehension, physiotherapy reassurance and education are essential in addressing client concerns and facilitating a smooth transition to early weight bearing. By adopting early weight-bearing strategies under professional guidance, clients can optimize their recovery and regain an active, independent lifestyle following orthopaedic surgery.

References:

1. Cunningham BP, Ali A, Parikh HR, Heare A, Blaschke B, Zaman S, Montalvo R, Reahl B, Rotuno G, Kark J, Bender M, Miller B, Basmajian H, McLemore R, Shearer DW, Obremskey W, Sagi C, O’Toole RV. Immediate weight bearing as tolerated (WBAT) correlates with a decreased length of stay post intramedullary fixation for subtrochanteric fractures: a multicenter retrospective cohort study. Eur J Orthop Surg Traumatol. 2021 Feb;31(2):235-243. doi: 10.1007/s00590-020-02759-3. Epub 2020 Aug 14. PMID: 32797351.

2. Deng, Z., Li, Z., Shen, C. et al. Outcomes of early versus late functional weight-bearing after the acute Achilles tendon rupture repair with minimally invasive surgery: a randomized controlled trial. Arch Orthop Trauma Surg 143, 2047–2053 (2023). https://doi.org/10.1007/s00402-022-04535-w

3. Rellensmann K, Baumbach SF, Böcker W, Polzer H. Nachbehandlung von operativ versorgten Sprunggelenkfrakturen : Was ist der aktuelle Wissensstand? [Aftercare following surgical treatment of ankle fractures : What is the current state of knowledge?]. Unfallchirurg. 2021 Mar;124(3):222-230. German. doi: 10.1007/s00113-021-00955-2. Epub 2021 Jan 29. PMID: 33512551.

4. Sharma, T. and Farrugia, P., 2022. Early versus late weight bearing & ankle mobilization in the postoperative management of ankle fractures: A systematic review and meta-analysis of randomized controlled trials. Foot and Ankle Surgery, 28(7), pp.827-835.

 

Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Phoebe has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.

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