Tumour & limb salvage: rehabilitation guide
Curettage and bone graft recovery: protected weight bearing on crutches for roughly 6–12 weeks while the bone fills in.
What is inside
18 minutes to read. Reviews: Wound review at about 2 weeks. Clinical review with an X-ray at 6 to 8 weeks, then a further X-ray review at about 3 months. These reviews govern each advance in weight bearing.
Harbour Orthopaedics & Sports Medicine
(02) 9052 1883 · drmatthewbroadhead.com.au
This is a general guide. Your operation record and the instructions you are given always take precedence over anything written here. Last reviewed 5 August 2026.
This guide covers recovery after curettage and grafting of a benign or locally aggressive bone lesion, such as a giant cell tumour or a bone cyst. It is written for you and for your physiotherapist, including a physiotherapist working with you a long way from Sydney, so everyone follows the same plan.
The central idea is different from most orthopaedic recoveries. The soft tissues here usually heal quickly. The hazard is FRACTURE through the cavity left in the bone. So this guide is built around one thing: a graduated, criteria-based weight-bearing plan, protected with crutches over roughly 6–12 weeks while the bone fills in.
These protocols are individualised, more so than joint replacement. How big the cavity is, where it sits, and whether it was filled with cement or graft all change the timeline. Every timeframe here is typical, not a rule: your operation record and your team’s instructions always govern, and each advance in weight bearing is your team’s call, not the calendar’s.
A curettage removes the lesion from inside the bone: a window is made in the bone’s wall and the abnormal tissue is carefully scraped out, leaving a clean cavity.
The cavity is then filled: either with bone graft (your own bone, donor bone or a bone substitute) or with bone cement. Which one was used matters for your timeline: cement is mechanically solid almost immediately, while graft is a scaffold that your body must slowly convert into living bone.
Until the cavity has filled in: biologically, or with cement plus the healing of the bone around it. The wall of the bone is thinner and weaker than normal at that spot. That temporary weakness, not the wound, is what the whole rehabilitation plan is protecting.
The skin and muscle usually heal within weeks. The bone is the slow part: the cavity left after curettage weakens it temporarily, and a fracture through that spot is the complication the whole plan is designed to prevent. Feeling good is not the same as being healed. The bone does not report its strength as pain.
Protected weight bearing with crutches, graduated over roughly 6–12 weeks, is what lets the bone fill in safely. You advance as pain settles AND X-rays show the defect filling: criteria, not dates. Ditching the crutches early is the one way to sabotage an otherwise excellent operation.
Cemented defects gain mechanical support almost immediately, so weight bearing usually advances earlier. Grafted defects need biological healing, living bone growing through the graft, and are protected longer. Larger defects, defects near a joint surface, and lower-limb weight-bearing bones are protected longest of all. Your team will tell you which clock you are on.
Protecting the bone does not mean resting the limb. The joints next to the operated bone start range-of-motion work early, the muscles are kept switched on from the first week, and the rest of your body trains normally. Protect one thing well; move everything else.
Each step up in weight bearing follows an X-ray showing the defect filling in, together with settling pain. That is why the review appointments matter so much. They are not just check-ins, they are the gates through which your rehabilitation advances.
Some of these lesions: giant cell tumour in particular: come back in a meaningful minority of patients, so surveillance imaging continues after you are back to full activity. It is routine, it is how everyone with these lesions is followed, and it is the reason recurrences are caught small.
Weight bearing
Protected weight bearing with crutches, graduated over roughly 6–12 weeks: criteria-based, and set by your team
Your operation record sets your starting level. It may be touch weight, partial weight or another specific instruction. If you are not sure what yours is, ask before you leave hospital, or call the rooms.
You advance through the stages below when the criteria are met: settling pain plus X-rays showing the defect filling in plus your team’s go-ahead, not when a set number of weeks has passed.
Cemented defects usually advance earlier, because cement supports load almost immediately. Grafted defects are protected longer while living bone grows through the graft. Larger defects, defects near a joint surface, and lower-limb weight-bearing bones are protected longest.
| Stage | Typical timing | Move on when |
|---|---|---|
| Two crutches, at the weight set in your operation record | From day one | The operation record governs: touch, partial or another set level; your physiotherapist checks your technique |
| Weight increases in steps | Typically from around 6 weeks: cemented defects often earlier, grafted defects later | Pain settling at the current level AND X-rays showing the defect filling in AND your team’s go-ahead |
| One crutch, then a stick | As your permitted weight approaches full | No limp at the permitted load; confident on level ground and stairs |
| No aid | Typically somewhere in the 6–12 week window: large, grafted, juxta-articular and lower-limb defects take longest | Full weight bearing cleared by your team; walking without a limp |
The wall of the bone is temporarily thinner and weaker where the cavity was. Until it fills in, loads it would normally shrug off can crack it. These rules exist only for that window. They are lifted in stages as the X-rays improve.
| Rule | Why | How to manage |
|---|---|---|
| Stick to your permitted weight: every step, every day | The bone cannot feel "almost healed". Overloading a defect that is still filling in is how fractures happen, and it usually happens on a good day, not a bad one. | Use the crutches exactly as taught, have your physiotherapist re-check your technique at each stage, and treat the permitted level as a ceiling, not a target to beat. |
| No running, jumping, or twisting on the operated limb until cleared | Impact and rotation concentrate force through the weakened section far beyond what walking does. | Low-impact work: cycling, pool work once the wound is healed, upper-body training, keeps you fit in the meantime. |
| Make your home and habits fall-proof | A stumble that a normal bone would tolerate can fracture a healing one. | Clear loose rugs and cords, light the path to the bathroom at night, take stairs with the crutch technique you were taught, and avoid wet or icy surfaces early on. |
| If the operation was in your arm, the same rules apply to lifting and leaning | An upper-limb defect is loaded by carrying, pushing up from chairs and catching yourself, not by walking. | Your team will set a lifting limit and show you how to get out of chairs without pushing through the operated arm. |
| Milestone | Earliest (weeks) | Typical | Latest |
|---|---|---|---|
| Walking with two crutches at your permitted weight | 0 | 0 | 1 |
| Wound review | 2 | 2 | 3 |
| Clinical review with X-ray: first weight-bearing advance for many | 6 | 7 | 8 |
| Weight bearing advancing in steps (cemented defects often earlier) | 6 | 8 | 12 |
| Walking without crutches (large or grafted defects take longest) | 6 | 10 | 14 |
| Three-month review with X-ray | 12 | 13 | 15 |
You move to the next phase by meeting its exit criteria, not by the calendar. The week numbers are typical, nothing more.
Let the wound settle, master crutch walking at your permitted weight, and start moving the joints next to the operated bone straight away.
Ready for the next phase when…
Hold the line on protected weight bearing while building range and gentle strength around the operated bone.
Ready for the next phase when…
Step the load up as the X-rays and your symptoms allow, and wean off the crutches in stages.
Ready for the next phase when…
Rebuild full strength, balance and confidence, return to work and activity in the right order, and settle into surveillance.
Ready for the next phase when…
Little and often beats one heroic session. Each exercise lists what you should feel, sharp pain that lingers afterwards means ease off and, if it persists, call.
Keep blood moving in the calf: your main clot-prevention exercise while walking is restricted.
10 firm pumps, every waking hour, for the first 2 weeks
Feel: You should feel the calf muscles working. Move through the full range each time.
Keep the thigh muscle switched on while the bone is protected, strength is far easier to keep than to rebuild.
10 holds of 5 seconds, 3–4 times daily
Feel: You should feel this in the front of the thigh. This loads the muscle, not the healing bone. It is safe from the first days.
Safe, correct walking that protects the healing bone: the single most important skill of the first six weeks.
Short, frequent walks through the day, building distance gradually
Feel: Weight goes through your hands, not your armpits. If you cannot feel how much weight you are taking, ask your physiotherapist to re-train it with scales: most people take more than they think.
Harder: Your team advances the permitted weight in steps; your physiotherapist re-checks technique at each step.
Manage stairs safely without overloading the operated limb.
Practise with supervision until confident; then as your home requires
Feel: "Good leg leads up." Use the rail plus one crutch if there is one: hand the second crutch to a helper.
The higher-risk direction on stairs, done slowly and in the right order, it is safe.
Practise with supervision until confident; then as your home requires
Feel: "Crutches and operated leg lead down." Slow is safe, never carry things downstairs in your hands early on.
Thigh strength without loading the healing bone through the foot.
10 lifts, hold 3 seconds, 2–3 times daily
Feel: If your team has restricted this movement for your particular lesion, their instruction wins: ask if unsure.
Easier: Static quadriceps sets until the lift is comfortable.
Soften and desensitise the scar once the wound is fully healed.
2–3 minutes, twice daily, from about 3 weeks once healed and dry
Feel: Firm enough to blanch the skin slightly; it should not be painful.
Fitness and joint range with the bone protected, only once your team approves it.
10–20 minutes, light resistance, most days: once cleared by your team
Feel: Smooth and easy: if you are mashing the pedals, the resistance is too high for this stage.
Real-world leg strength, added as your permitted weight advances.
2–3 sets of 8–10, once or twice daily, once your team has cleared the load
Feel: Early on, the arms and the good leg do the extra work; share the load evenly only once full weight bearing is cleared.
Harder: Less hand support, then a lower chair, as clearance advances.
Calf strength for a normal push-off: added in the graduated-loading phase.
2–3 sets of 10, once or twice daily: once cleared
Feel: Keep within your permitted weight on the operated side until full weight bearing is cleared.
Harder: Gradually even weight, then more onto the operated side.
Steadiness and confidence for the return to full activity: the final rebuilding block.
Build to 3 holds of 30 seconds each leg, daily, once full weight bearing is cleared
Feel: Quiet foot, tall posture. This one waits for full weight-bearing clearance. It loads the whole limb through one leg.
Sleep in whatever position is comfortable. There are usually no positional restrictions after curettage and grafting. If your team has given you a specific instruction for your lesion, theirs wins.
A pillow supporting the operated limb often helps in the first weeks.
Getting up at night is the riskiest walk of the day: keep the crutches within reach of the bed, light the path, and never do the trip without them. A half-asleep shortcut is exactly how a protected bone gets overloaded.
Expect surgical pain for the first one to two weeks, needing regular pain relief, then a steady settling. Take medication as prescribed and ahead of physiotherapy rather than chasing pain afterwards.
A deep ache in the bone with activity, easing with rest, is normal for some months. It is the sound of bone healing, not of trouble.
The pattern that matters is the trend: pain should be settling week on week at each weight-bearing level. Pain that is suddenly worse, or clearly increasing, is a warning sign, stop weight bearing and call (see the warning signs section).
Take any prescribed blood thinner exactly as directed while your walking is restricted.
You may drive when all of the following are true:
What the research actually measures is braking reaction time on a simulator. Those studies show braking performance returns to its pre-operative level at about 2 weeks after a right hip replacement and about 4 weeks after a right knee replacement, with movement time back to normal by 6 weeks. After knee arthroscopy the simulator evidence is more conservative than common practice: in the one study that measured it directly, braking was still slower one week after surgery than before it, and had recovered by four weeks, and a 2021 review of eight studies put the average return at about six weeks. Most people having a simple arthroscopy are driving well before that, which is why the criteria above matter more than the date. But these are averages, in one study, about one in three right-hip patients still could not meet an emergency-stop benchmark at six weeks. Treat the timeframes in this guide as targets for discussion with us, not as permissions.
No published study has compared automatic and manual cars. The logical point is simply that a manual needs the left leg for the clutch, so left-sided surgery is the relevant caution in a manual. Advice about driving earlier with a left-leg operation in an automatic is clinical judgement, not trial evidence.
In Australia, your treating doctor’s advice governs: under the Austroads "Assessing Fitness to Drive" standards, temporary post-operative impairment is a matter of clinical judgement, and commercial drivers are held to a higher standard. Driving while impaired may invalidate your insurance, check your insurer’s position. Do not drive for at least 24 hours after any general anaesthetic or sedation.
| Activity | Typical | When it’s right | Notes |
|---|---|---|---|
| Walking for exercise | From the outset, with crutches, at your permitted weight | Safe technique; wound settled | Distance builds within the permitted level; the level itself advances only at reviews |
| Desk work | Often within a few weeks | Comfortable sitting; safe travel sorted; pain controlled | Crutch commuting is the usual limiting factor: talk to your employer early |
| Swimming and pool walking | Once the wound is fully healed and reviewed | Wound closed and team-cleared | A good early fitness option: the water carries the weight the bone cannot yet take |
| Stationary cycling | When your team approves, often in the protected phase | Team go-ahead for your particular defect | Light resistance; fitness tool, not a strength test |
| Driving | Individualised, usually once off crutches for the operated side | The standard driving criteria in this guide, plus your team’s agreement | A right-leg defect and a manual car are the cautious combinations: discuss at a review |
| Physical work | After full weight bearing is cleared and X-rays show consolidation | Strength and endurance for the actual duties; team clearance | Modified duties are often the bridge back |
| Low-impact sport and gym work | After full weight-bearing clearance | No limp; strength rebuilt; team agreement | The first rung of the return-to-sport ladder |
| Running, jumping and pivoting sports | Last, on specific clearance | X-ray consolidation, full strength, and your team’s explicit go-ahead | Impact is the load the healing defect tolerates worst, so it returns last |
You will often hear "no flying for six weeks" after joint replacement. Be aware that this is a convention, not a proven rule: a 2025 review found limited data and no demonstrated difference in clot risk between people who did and did not fly after hip or knee replacement: mostly within the first week.
The six-week convention reflects practical realities rather than trial evidence: managing airports and cramped seating, being past the highest-risk clot window while still on prevention, the higher baseline clot risk of long-haul flights over four hours, and individual airline and travel-insurance rules, check both, as some airlines impose their own restrictions.
If you need to travel long-haul in the first six weeks, talk to the rooms first so clot prevention, an aisle seat, stockings and on-board movement can be planned.
None of these should be watched overnight to see how they go. Early treatment of a problem is simple; late treatment is not.
EMERGENCY: 000Emergency department / call 000
GP TODAYSee your GP today
CALL THE ROOMSCall the rooms: same day
For joint replacement patients, a wound problem is never something to "wait and see". Early treatment of an infected joint replacement is vastly more successful than late treatment, call the rooms the same day.
Typically the progression runs over roughly 6–12 weeks, but it is criteria-based rather than calendar-based: you advance as pain settles AND X-rays show the defect filling in AND your team gives the go-ahead. Cemented defects usually advance earlier because cement supports load almost immediately; grafted defects wait for biological healing. Larger defects, defects near a joint surface, and lower-limb weight-bearing bones are protected longest. Your operation record sets your starting level, if you are unsure what yours is, ask.
Curettage scrapes the lesion out from inside the bone, which leaves a cavity, and until that cavity fills in, the wall of the bone at that spot is thinner and weaker than normal. The soft tissues heal in weeks; the bone takes months. That temporary weakness is why the whole plan revolves around protected, graduated weight bearing: the hazard here is a fracture through the residual cavity, not the wound.
They fill the same cavity on different clocks. Bone cement hardens within minutes of surgery, so it gives mechanical support almost immediately, which is why cemented defects can usually take weight earlier. Bone graft is a scaffold that your body gradually converts into living bone; that biological healing takes months, so grafted defects are protected longer. Neither is "better" in general: your surgeon chooses based on the lesion, its size and its position, and your weight-bearing plan follows from that choice.
Four things: a sudden increase in pain; a crack or snap you feel or hear; a new inability to take weight you could take yesterday; and any new deformity: a change in the shape or line of the limb. If any of these happens: stop weight bearing, get back on the crutches, and contact the rooms for urgent review and imaging. Do not walk on it to "see how it goes". A promptly checked false alarm costs an X-ray; a walked-on fracture costs far more.
These lesions are benign or locally aggressive, but "locally aggressive" earns its name: giant cell tumours in particular come back in a meaningful minority of patients after curettage. That is not a reason for alarm; it is the reason for the follow-up plan. Surveillance imaging continues after the bone has healed, on a schedule your team sets, so that if a recurrence ever happens it is caught small and dealt with early. Keep the appointments even when you feel completely normal, and report any new or returning pain between them.
Not necessarily: "protected weight bearing" comes in levels, from touch weight through partial weight to a set share of your body weight, and your operation record states yours. What matters is sticking to that level precisely: most people take more weight than they think, so ask your physiotherapist to check your technique, standing on bathroom scales is a simple way to calibrate what your permitted weight actually feels like.
Months, not weeks. The graft is a scaffold that your body converts into living bone, and that biological process cannot be rushed. You will not feel it happening, which is exactly why the X-rays matter: each review X-ray shows how the defect is filling in, and each advance in your weight bearing follows what the X-ray shows. The reviews at around 6 weeks and 3 months are the gates your recovery advances through.
Because the wound and the bone heal on completely different timelines. The skin and muscle are usually settled within a few weeks; the cavity in the bone takes months to fill in, and it does not report its progress as pain, feeling good is not the same as being healed. The crutches are the treatment during that gap. The X-rays, not how the leg feels, tell your team when the bone is ready for more.
There is no fixed week: it depends on which limb was operated on, your permitted weight bearing, and the standard criteria: off strong painkillers, able to sit comfortably, able to perform an emergency stop at full force without hesitation, and not relying on an aid in the car. For a right-leg defect that usually means waiting until your weight bearing has advanced enough to brake hard safely. Agree the timing with your team at a review, and practise in a stationary car first.
Yes: please do. Protecting the operated bone is not resting the rest of you: upper-body training, trunk work, the other limb, and (once the wound is healed) pool work are all encouraged, and the joints next to the operated bone should be doing range-of-motion work from early on. The people who transition fastest once full weight bearing is cleared are the ones who kept everything else strong in the meantime.
| Claim | Source |
|---|---|
| Giant cell tumour of bone recurs locally after curettage in a meaningful minority of patients; reported rates vary widely with technique and adjuvant use | Klenke et al., giant cell tumour of bone, risk factors for recurrence, Clin Orthop Relat Res 2011 (PMID 20706812); Errani et al., 349 cases from a single institution, Cancer Treat Rev 2010 (PMID 19879054) |
| Most local recurrences of giant cell tumour occur within the first 2–3 years, which is what shapes the surveillance imaging schedule | Errani et al., giant cell tumour of the extremity, 349 cases from a single institution, Cancer Treat Rev 2010 (PMID 19879054); Klenke et al., risk factors for recurrence, Clin Orthop Relat Res 2011 (PMID 20706812) |
| Bone cement (PMMA) provides immediate mechanical stability of the defect, whereas bone graft requires biological incorporation over months before it can share load | Hirn et al., bone defects following curettage do not necessarily need augmentation, Acta Orthop 2009 (PMID 19234881); Roberts & Rosenbaum, bone grafts, bone substitutes and orthobiologics, Organogenesis 2012 (PMID 23247591). The Fraquet reference previously cited here could not be located in Europe PMC and has been replaced |
| Fracture through the residual cavity is a recognised complication after curettage of benign bone lesions during the healing period | Hirn et al., bone defects following curettage do not necessarily need augmentation, Acta Orthop 2009 (PMID 19234881) |
| Bone graft incorporation is a staged biological process: revascularisation, resorption and new bone formation: occurring over months | Roberts & Rosenbaum, bone grafts, bone substitutes and orthobiologics, Organogenesis 2012 (PMID 23247591) |
| Graduated, criteria-based weight bearing after curettage and grafting reflects consensus practice in orthopaedic oncology units; there are no controlled trials of specific progressions | Unit protocol and consensus practice, not trial evidence. No randomised comparison of weight-bearing regimes after curettage and grafting exists |
Protocols after curettage and grafting are more individualised than after joint replacement: the size, site and filling of your defect all change the plan. Your operation record and your team’s instructions always govern, and every advance in weight bearing is your team’s call.
This guide is general information for patients of Dr Matthew Broadhead (Harbour Orthopaedics & Sports Medicine) and is not a substitute for the specific advice given to you by Dr Broadhead, your physiotherapist or your hospital team.
Surgical findings vary, and your protocol may differ from what is written here: your operation record and your surgeon’s instructions always take precedence.
If in doubt, call the rooms on (02) 9052 1883. In an emergency, call 000.
Last reviewed: 2026-08-05 by Dr Matthew Broadhead, FRACS (Orth).
Fill this in once a week: it shows your trend at a glance and makes reviews far more useful. Bring it to every appointment.
| Week | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 |
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| Exercises done (sessions) | ||||||||||||
| Walking distance / time | ||||||||||||
| Pain score (0–10) | ||||||||||||
| Knee bend (degrees) | ||||||||||||
| Swelling (less / same / more) |
Questions for Dr Broadhead