Knee Surgery Recovery: How to Properly Use a Cane

How to Use a Cane After Knee Surgery?

Using a cane after knee surgery is crucial for providing stability, reducing pain, and protecting the healing joint by properly distributing weight and aiding balance during ambulation.

The Role of a Cane After Knee Surgery

Following knee surgery, the joint is in a vulnerable state, requiring protection and controlled loading to facilitate optimal healing. A cane serves as a vital assistive device, offloading stress from the surgical site, improving balance, and reducing the risk of falls. It allows for safer ambulation, promoting early mobility while ensuring the integrity of the repaired structures. The specific weight-bearing status prescribed by your surgeon or physical therapist (e.g., non-weight-bearing, touch-down weight-bearing, partial weight-bearing, weight-bearing as tolerated) will dictate how much support the cane provides.

Selecting the Appropriate Cane

Choosing the right cane is the first step towards effective and safe use. While various types exist, a single-point cane (often an offset cane) is most commonly recommended for post-knee surgery recovery due to its balance of support and maneuverability.

• Single-Point Cane: Provides moderate support and is easy to manage. Offset handles are generally preferred as they distribute weight more directly over the shaft, enhancing stability.
• Quad Cane: Offers a wider base with four points of contact, providing more stability than a single-point cane. While offering greater support, it can be cumbersome and may not be necessary unless significant balance deficits are present. Your surgeon or physical therapist will advise if a quad cane is appropriate.

Key Features to Consider:

• Handle Comfort: Choose a handle that fits comfortably in your palm and allows for a firm grip without causing undue pressure.
• Adjustability: Ensure the cane's height can be easily adjusted to fit your stature.
• Tip Stability: Look for a cane with a durable, non-slip rubber tip that provides good traction.

Achieving Proper Cane Sizing

Correct cane sizing is paramount for ergonomic efficiency, stability, and injury prevention. An improperly sized cane can lead to poor posture, increased strain on other joints (e.g., back, shoulders), and diminished support.

To size your cane correctly:

1. Stand Tall: Stand upright with your shoulders relaxed and your arm hanging naturally at your side.
2. Cane Placement: Place the cane approximately 6 inches (15 cm) to the side of your foot.
3. Elbow Bend: The top of the cane handle should align with the crease of your wrist. When holding the cane, your elbow should have a slight bend of approximately 15-30 degrees. This slight bend allows for optimal force transfer and comfortable grip.
4. Confirm Alignment: Ensure your posture remains upright, not leaning over the cane.

Mastering the Gait Pattern with a Cane

The fundamental principle for using a cane after knee surgery is to hold the cane on the unaffected (stronger) side of your body. This allows the cane to effectively share the load with your stronger leg, reducing weight on the surgical knee.

General Gait Pattern for Flat Surfaces:

1. Advance the Cane: Move the cane forward approximately one step's length.
2. Advance the Injured Leg: Step forward with your surgical leg, bringing it even with the cane. Allow the cane to bear some of your weight, reducing stress on the healing knee.
3. Advance the Uninjured Leg: Step through with your uninjured leg, moving it past the cane and the surgical leg.
4. Repeat: Maintain a smooth, rhythmic pace. Ensure your steps are even and controlled.

Specific Gait for Different Weight-Bearing Statuses:

• Touch-Down Weight-Bearing (TDWB) or Partial Weight-Bearing (PWB): The cane takes the majority of your weight. You will gently touch your surgical foot to the ground for balance or bear only a prescribed percentage of your body weight.
• Weight-Bearing As Tolerated (WBAT): You can place as much weight as comfortable on your surgical leg, with the cane providing additional support and balance as needed.

Navigating Stairs and Curbs Safely

Stairs and curbs present unique challenges. Remember the mnemonic: "Up with the good, down with the bad." Always use a handrail if available for added support.

Ascending Stairs (Up with the Good):

1. Cane on Affected Side: Hold the cane in the hand opposite your surgical leg (i.e., on your good side), or use a handrail.
2. Lead with Uninjured Leg: Step up onto the next step with your uninjured leg.
3. Bring Up Cane and Injured Leg: Bring the cane and your surgical leg up to the same step.
4. Repeat: Continue this sequence, one step at a time.

Descending Stairs (Down with the Bad):

1. Cane on Affected Side: Hold the cane in the hand opposite your surgical leg (i.e., on your good side), or use a handrail.
2. Lead with Cane and Injured Leg: Place the cane on the step below, followed immediately by your surgical leg.
3. Bring Down Uninjured Leg: Bring your uninjured leg down to the same step.
4. Repeat: Continue this sequence, one step at a time.

Sitting Down and Standing Up with Cane Support

Transitions require careful technique to prevent falls and protect your knee.

Sitting Down:

1. Back Up: Back up until the backs of your legs touch the chair.
2. Cane and Hand: Keep the cane within reach. Reach back with one hand for the armrest or seat of the chair, while keeping the cane in the other hand or propped nearby.
3. Lower Slowly: Lower yourself slowly, using your strong leg and arm for support. Extend your surgical leg slightly forward to avoid putting weight on it as you sit.

Standing Up:

1. Position Cane: Position the cane on your stronger side, within easy reach.
2. Push Up: Use your arms to push off the armrests or seat of the chair.
3. Lead with Strong Leg: Push up primarily through your uninjured leg. As you stand, place your weight onto your uninjured leg and the cane, keeping your surgical leg slightly forward until you are fully upright and stable.
4. Regain Balance: Once standing, pause to ensure your balance before beginning to walk.

Common Mistakes to Avoid

• Using the Cane on the Wrong Side: Holding the cane on the same side as your surgical knee can reduce its effectiveness and place more strain on the injured joint.
• Incorrect Cane Height: A cane that is too tall or too short can lead to poor posture, back pain, and instability.
• Leaning Heavily on the Cane: While the cane provides support, excessive leaning can create new imbalances and strain on your upper body. The goal is to offload weight, not to completely replace your leg's function.
• Looking Down at Your Feet: Maintain an upright posture and look forward, not down, to anticipate obstacles and maintain balance.
• Rushing: Take your time with each step and transition. Rushing increases the risk of falls.
• Ignoring Pain: If you experience increased pain while using the cane or during activity, stop and consult your physical therapist or surgeon.

When to Consider Weaning Off the Cane

The decision to transition off the cane should be made in consultation with your surgeon or physical therapist. They will assess your progress based on several factors:

• Pain Levels: Significantly reduced or absent pain during weight-bearing activities.
• Strength: Sufficient quadriceps and hamstring strength to support your body weight without compensatory movements.
• Balance: Demonstrated ability to maintain balance independently during walking and transitions.
• Gait Symmetry: A more symmetrical and normalized walking pattern without limping.
• Confidence: Feeling secure and stable without the cane.

Gradual weaning is often recommended, perhaps starting with using the cane only for longer distances or on uneven terrain, before phasing it out completely.

Important Considerations and Professional Guidance

• Follow Medical Advice: Always adhere strictly to your surgeon's and physical therapist's instructions regarding weight-bearing status and activity restrictions.
• Listen to Your Body: Pain is a signal. Do not push through pain.
• Home Safety: Clear pathways, remove rugs, and ensure adequate lighting in your home to prevent falls.
• Consistent Practice: Regular, correct use of the cane will improve your confidence and mobility.
• Physical Therapy is Key: A physical therapist will provide personalized guidance, exercises, and progression strategies essential for a safe and effective recovery. They are your primary resource for mastering cane use and regaining functional independence.