When Can You Stop Using Crutches After Hip or Knee Replacement?

Polish version

After an uncomplicated hip or knee replacement, the decision to stop using crutches should not be based on the number of days since surgery alone. What matters most is whether you can walk safely, without a clear limp or giving way of the operated leg, with adequate balance and muscle control. Many patients begin weight-bearing very early, often as tolerated, but progression from two crutches to one and then to unaided walking should reflect the operation performed and the individual postoperative instructions.

Can you put weight on the operated leg immediately after joint replacement?

After a typical, stable primary hip or knee replacement, contemporary recovery programmes favour early mobilisation and getting out of bed as soon as practical. ERAS recommendations for hip and knee replacement support early mobilisation, while current physical therapy guidance after total knee arthroplasty emphasises early recovery of walking, balance and efficient movement patterns.

For uncemented total hip arthroplasty, a meta-analysis of 17 studies found no evidence that immediate unrestricted weight-bearing increased excessive stem micromotion, failure of bone integration or revision risk compared with partial weight-bearing. This does not mean, however, that every patient after every operation may load the leg without restriction.

When may the instructions be different?

Temporary weight-bearing restrictions may be needed after revision surgery, an intraoperative or periprosthetic fracture, bone grafting, an osteotomy, repair of additional soft-tissue structures, or whenever the reconstruction needs protection while healing. For that reason, the operating surgeon’s discharge instructions take priority over any general rehabilitation timetable.

How do patients usually progress from two crutches to one?

A common sequence is a walking frame or two crutches, followed by one crutch or a walking stick, and finally unaided walking. There is no requirement for every patient to move through each stage at the same time.

• Two crutches or a walking frame are useful while gait remains uncertain, the leg is weak, pain limits loading or there is a meaningful risk of losing balance.
• One crutch or a walking stick may be the next step when the patient can safely transfer weight onto the operated leg without clearly increasing the limp.
• Unaided walking is best introduced when removing support does not worsen gait quality.

When one crutch or a walking stick is used after hip or knee surgery, it is usually held on the side opposite the operated leg. This reduces the demand on the muscles that stabilise the pelvis and can help maintain a better gait pattern.

How can you tell when it is reasonable to try walking without crutches?

Functional criteria are more useful than a fixed date. Reducing support is reasonable when:

• you can walk on a level surface without a pronounced limp;
• the operated leg does not feel as though it is giving way or suddenly buckling;
• your balance allows you to turn, stop and rise from a chair safely;
• pain and swelling remain controlled after increasing your step count;
• after knee replacement, quadriceps control is sufficient to keep the knee stable during weight-bearing;
• after hip replacement, pelvic control is sufficient and walking without a crutch does not produce marked trunk leaning;
• the orthopaedic surgeon has not prescribed a temporary weight-bearing restriction.

Is it better to keep one crutch for longer or stop using it as soon as possible?

If walking without the crutch produces a clear limp, shorter steps, trunk leaning or reluctance to load the operated leg, it is usually more sensible to continue using support for a while and work on strength and gait quality. The goal is not to “get rid of the crutches” as quickly as possible, but to regain safe and reasonably symmetrical walking.

Conversely, there is no benefit in continuing with two crutches purely out of habit when there are no loading restrictions, walking is stable and the patient can reduce support without deteriorating gait. Current guidance after knee replacement emphasises functional training, balance and gait retraining rather than the passage of time alone.

What if pain or swelling increases after reducing support?

A temporary increase in muscle fatigue after greater activity can occur. If changing the way you walk clearly increases pain, swelling or limping, reduce the load and briefly return to the previous level of support. Symptoms that worsen from day to day should prompt assessment of the cause rather than continued attempts to push through them.

When should you seek urgent assessment rather than wait for a routine review?

Urgent assessment is particularly important if there is:

• sudden shortness of breath, chest pain or fainting;
• markedly increasing one-sided calf swelling with pain or tenderness;
• fever accompanied by increasing redness, warmth or wound drainage;
• sudden severe pain after a fall or twisting injury;
• a new deformity, obvious limb shortening or inability to bear weight after previously making progress;
• a sudden substantial loss of function instead of gradual improvement.

Stopping crutches is only one stage of recovery

Independent walking does not mean rehabilitation is complete. Strength, balance and tolerance of longer periods of activity continue to improve. Readiness for driving, returning to work and returning to sport should be assessed separately rather than inferred simply from the ability to walk without a crutch.

Back to: Before and After Orthopaedic Surgery

References

1. Bove AM, Carroll LA, Cone S, et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Physical Therapy. 2026;106(7). DOI: 10.1093/ptj/pzag058.
2. Huang L, Han W, Qi W, et al. Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis. Front Surg. 2023;10:1225649. DOI: 10.3389/fsurg.2023.1225649.
3. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Acta Orthop. 2020;91(1):3–19. DOI: 10.1080/17453674.2019.1683790.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.