Weight-Bearing Restrictions after Acetabular Fracture, Necessity or Hope? A Brief Observational Study

Doctor, When Should I Start Walking? Revisiting Postoperative Rehabilitation and Weight-Bearing Protocols in Operatively Treated Acetabular Fractures: A Systematic Review and Meta-Analysis

“…The reason why restricted or limited delayed weight-bearing after acetabular fracture fixation is preferred among surgeons is unclear, as most orthopedic surgeons routinely prescribe at least partial weight-bearing for a lower extremity fracture in an attempt to produce an optimal mechanical environment at various stages of fracture healing [ 41 ]. From a biomechanical point of view, weight-bearing produces micromovements between the fracture fragments, stimulating bone consolidation, which clinically implies rapid functional recovery and a faster return to activities of daily living, thus potentially reducing complications associated with late rehabilitation protocols [ 42 , 43 ].…”

“…However, the literature on weight-bearing status after fixation of an acetabulum fractures continues to empirically suggest at least 6 weeks of non-weight-bearing as the most prevalent postoperative treatment option, mainly due to fear of implant failure, fracture displacement, and loss of reduction. This more conservative recommendation appears to be motivated by the belief that by reducing the forces acting at the fracture site, the bone and ligament healing processes will occur without greater risk of fixation failure [ 42 , 43 , 44 ]. In fact, in the 22 studies included [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], we consistently observed that active and passive hip movements and isometric quadriceps- and abductor-strengthening exercises were started between one and three days postoperatively, and weight bearing was basically postponed depending on the patient’s general condition and fracture healing state.…”

“…In fact, in the 22 studies included [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], we consistently observed that active and passive hip movements and isometric quadriceps- and abductor-strengthening exercises were started between one and three days postoperatively, and weight bearing was basically postponed depending on the patient’s general condition and fracture healing state. Interestingly, non-weight bearing has been shown to be associated with greater energy expenditure and higher contact pressures at the hip joint, with peak pressures in the acetabulum during sitting and standing activities performed during restricted weight-bearing being nearly three times the forces observed during walking [ 42 , 43 , 45 , 46 ]. Moreover, much of the force during sitting and standing activities is directed posteriorly, whereas during ambulation, more load is distributed to the upper lateral surface of the roof [ 42 , 45 , 46 ].…”

“…Interestingly, non-weight bearing has been shown to be associated with greater energy expenditure and higher contact pressures at the hip joint, with peak pressures in the acetabulum during sitting and standing activities performed during restricted weight-bearing being nearly three times the forces observed during walking [ 42 , 43 , 45 , 46 ]. Moreover, much of the force during sitting and standing activities is directed posteriorly, whereas during ambulation, more load is distributed to the upper lateral surface of the roof [ 42 , 45 , 46 ].…”

“…No significant influence on weight-bearing performance was found regarding sex, age, language spoken, body mass index, time in a cast, or the treating surgeon. Braun et al [ 42 ] continuously monitored 10 patients after surgical treatment of an acetabulum fracture with a pressure-measuring insole. In the postoperative protocol, the authors instructed every patient to maintain a 20 kg weight-bearing limit for 6 weeks, but only one patient stayed within the weight-bearing limit during the analysis.…”