Partial Weight-Bearing after Lower Extremity Surgery: A Review of Current Standards, Innovations, and Patient Compliance

Document Type : CURRENT CONCEPTS REVIEW

Authors

1 Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA

2 Rothman Orthopaedics Florida at AdventHealth, Orlando, FL, USA

3 Villanova University, College of Engineering, Villanova, PA, USA

10.22038/abjs.2025.88277.4000

Abstract

Partial weight bearing (PWB) is a cornerstone of post-operative rehabilitation after lower extremity surgery (LES), balancing mechanical stimulation needed for bone, tendon, and cartilage healing with protection against excessive load that precipitates malunion, non-union, or joint dehiscence. This narrative review synthesizes literature to clarify current indications for PWB, evaluate traditional and emerging methods for prescribing and monitoring load, and identify factors influencing patient adherence. Hip, knee, ankle, and foot procedures commonly warrant PWB, yet optimal targets and progression schedules remain surgeon-dependent and inconsistently standardized. Household scales fail to replicate dynamic gait and are associated with poor long-term accuracy when compared to biofeedback devices, although these are the most widely adopted PWB adjuncts. Recent clinical trials demonstrate that wearable pressure-sensing insoles, audio or visual biofeedback, smartphone applications, telerehabilitation platforms, and virtual/augmented reality (VR/AR) or robotic off-loading devices markedly improve PWB precision, range of motion, muscle preservation, and functional scores without increasing complications. Nevertheless, widespread adoption is limited by cost, device sizing, battery life, and the requirement for continuous wear. Across studies that objectively quantified loading, adherence remains suboptimal, particularly among elderly and obese patients, underscoring the need for targeted educational interventions. Formal patient education, integrated into routine follow-up, may enhance understanding of PWB rationale, foster self-efficacy, and amplify the benefits of technology. Future research should prioritize high-quality randomized trials that combine sensor-derived compliance metrics with machine-learning analytics to individualize loading protocols, elucidate the drivers of non-adherence, and determine the cost-effectiveness of digital health solutions. Standardizing PWB guidelines while leveraging wearable, telehealth, and VR/AR technologies holds promise for accelerating recovery, reducing revision surgeries, and improving quality of life in an aging, fracture-prone population.
        Level of evidence: III

Keywords

Main Subjects

References

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The Archives of Bone and Joint Surgery
Volume 14, Issue 1
January 2026
Pages 16-23

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History

  • Receive Date: 16 May 2025
  • Revise Date: 29 December 2025
  • Accept Date: 23 June 2025

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