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General Joint Surgery Information
Canes: Why? How? When?
By Cindy Ayers, PT TCJR
Fact: The usage of a single tip cane will
actually unload weight from the involved leg by 1/3, thereby
greatly diminishing the forces and decreasing pain across the
hip and knee when walking.
Fact: During the walking cycle, approximately
3 times body weight is transferred to the weight-bearing leg
at each step. During stair climbing, 7-8 times body weight is
transferred over the same involved leg.
Cane: By definition (in our practice) is a
non-addictive, inexpensive, appliance that can greatly enhance
the comfort level of a patient during the walking or gait cycle
either before or after surgery.
The utilization of a cane is quite helpful to unload or reduce
the stress across a diseased joint prior to surgery, and is
definitely a very important part of the post-operative recovery
phase. The recommendation to use a cane is not solely based
on, "What can I do to make the patient the most miserable?"
as I think some our patients feel. It is actually based on some
very real criteria concerning walking smoothly, and some education
on walking and moving in ways to ease pain and limping. The
advancement off the cane, after surgery, is not based on a time
factor, but is based on the smoothness of the patient's walking
pattern. When your muscles are ready to assume the load of walking
again, coming of the cane is easy.
Which hand does the cane go in? Well, don't watch old movies
or even the newer sitcoms like "Frasier." I think
if Frasier's dad had worked with a real physical therapist or
even seen a knowledgeable orthopedist, he would not have spent
years walking with the cane on the injured side. The placement
of a cane actually goes on the opposite side. Think of soldiers
marching. When they extend their right leg, it is their left
arm that comes forward. We are bipedal (walk on two legs —
or at least try to). If the cane is placed on the opposite side
(contralateral side) of the bad leg it accomplishes a few things
1) it widens the base of support — making a patient more
stable. 2) It allows the forces across the hip and knee of the
opposite leg to be diminished by 1/3 which creates less stress
on the muscles, diminishes the reports of pain with weight bearing,
and will smooth out the walking pattern — typically, almost
resolving any limp.
Bottom line — use a cane if it helps. It can be advisable
to use a cane before surgery, definitely after surgery, and
for some revision surgeries or very complicated cases, for many
years. Let us help you make the decision on what cane is best
for you and when and how long to use it. We are the experts.
There is a wide variety of canes available to suit your tastes
and level of activities. Are you aware, that there are telescoping
canes available? These canes are great for walkers on hills
and rough terrain. The canes look like ski poles. It is actually
quite the fashionable thing to use for exercising outdoors.
These robust exercisers don't even have joint replacements.
I believe the hardest thing for patients is that we tend to
think of canes as devices that "old people" use. But
that belief really doesn't hold water anymore. The choice is
obviously yours. Do I use a cane, or not use a cane? Personally,
I love canes.
For the right patient, a cane is simple, easy to use and most
importantly, non-habit forming. Stop by and let me see your
special or favorite cane. I've really seen some great ones over
the years and always enjoy seeing canes that express their owners'
personalities.
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