Rehabilitation Loading Streams

OGAAP-3 formalises four stratified rehabilitation streams—immediate fitting, standard loading, slow loading, and delayed loading—replacing the previous two-category system from OGAAP-2. Standard loading begins axial loading at 5 kg on day 1–2, increasing by 5 kg daily until 50% of body weight is reached. Slow loading increases axial load only weekly by 5 kg, representing a substantially more gradual ramp than the standard protocol. Delayed loading applies no axial load for the first 6 weeks postoperatively to allow biological integration at the bone–implant interface. Stream assignment is determined by intraoperative bone quality, residual limb characteristics, and patient physiological factors. Delayed loading is reserved for patients with short residual femurs under 120 mm, limb lengthening history, advanced osteoporosis, or metaphyseal-only tibial contact. The immediate fitting stream is particularly advantageous for bilateral transfemoral amputees, for whom early mobilisation is critical.