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

Partial weight bearing (PW B) 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 mal union, non-union, or joint dehiscence.This narrative review synthesizes literature to clarify current indications for PW B, evaluate traditional and emerging methods for prescribing and monitoring load, and identify factors influencing patient adherence.Hip, knee, ankle, and foot procedures commonly warrant PW B, 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 PW B 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 PW B 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 c ontinuous wear.Across studies that objectively quantified loading, adherence remains suboptimal, particularly among elderly and obese patients, underscoring the need for targeted educational interventions.F ormal patient education, integrated into routine follow -up, may enhance understanding of PW B 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 PW B guidelines while leveraging wearable, tele health, and VR/AR technologies holds promise for accelerating recovery, reducing revision surgeries, and improving quality of life in an aging, fracture-prone population.