Post-Opera5ve Use of the Wheeled Knee Walker a<er Foot and Ankle Surgery

Transcription

1 Post-Opera5ve Use of the Wheeled Knee Walker a<er Foot and Ankle Surgery AOFAS ANNUAL MEETING EPOSTER, JULY 12-15, 2017 JANE C. YEOH MD DAVID J. RUTA MD G. ANDREW MURPHY MD DAVID R. RICHARDSON MD SUSAN N. ISHIKAWA MD BENJAMIN J. GREAR MD CLAYTON B. BETTIN MD RICHARD A. SMITH PHD

2 Disclosures Post-Opera5ve Use of the Knee-Walker a<er Foot and Ankle Surgery NO CONFLICTS OR POTENTIAL CONFLICTS TO DISCLOSE REGARDING THIS STUDY Jane C. Yeoh MD Susan N. Ishikawa MD David J. Ruta MD Benjamin J. Grear MD G. Andrew Murphy MD Clayton B. BeSn MD David R. Richardson MD Richard A. Smith PhD Our AAOS Disclosures are updated in the Final Mobile App

3 Background To our knowledge, first orthopaedic knee walker (orthopaedic scooter, knee roller) was described in , 4 Wheeled knee walker (KW) has grown in popularity Compared to axillary crutches, knee walkers: Be_er assisted ambula5on 2, 3 Lower perceived exer5on 2.3 Higher sa5sfac5on 2 Paucity of literature about knee walkers, no studies on knee walkers in clinical popula5on Fig. 1 The orthopaedic scooter. From: Roberts P, Carnes S. The Orthopaedic Scooter. An energy-saving aid for assisted ambulaaon. J Bone Joint Surg Br. 1990;72(4):

4 Post-OperaAve Use of the Wheeled Knee-Walker aker Foot and Ankle Surgery Goal Quan5fy and describe pa5ent use of knee walkers a<er foot and ankle surgery in the group prac5ce of foot and ankle surgeons Iden5fy any associa5ons between knee walker-related falls and pa5ent characteris5cs

5 Methods Ins5tu5onal review board approval obtained Retrospec5ve, observa5onal, and descrip5ve study Paper and electronic surveys sent to 691 pa5ents Data were collected from June 2016 to January 2017 Inclusion Criteria 18 years Unilateral foot or ankle surgery Physician-instructed nonweight bearing status Given the option of using the knee walker from March 2015 to April 2016 Sta5s5cs Pearson chi-square analysis for discrete variables Independent samples T-test for con5nuous variables

6 Results Sex Age Demographics (n = 80) 51 females 29 males Comorbidities Average ± 13.0 years (range 21 to 85 years) 18 / 80 (23%) were 65 years old Steerable KW Non-steerable KW Knee walker characteristics (n = 80) 4 wheels 3 wheels, single wheel in front 3 wheels, single wheel in back 77 / 80 (96%) 3 / 80 (4%) 69 / 80 (86%) 8 / 80 (10%) 3 / 80 (4%)

7 Results Patient prior experience and education (n = 80) Prior experience with walking aid (crutches, cane, walker, wheel-chair) Prior experience with wheeled KW No prior experience with any walking aid Instruction about use of KW (KW rep, PT, other) No instruction 42 / 80 (53%) 0 / / 80 (46%) 27 / 80 (34%) 53 / 80 (66%) Knee walker use 7.2 ± 5.5 weeks 4.1 ± 3.9 hours/day

8 Results Fall(s) Single fall Multiple ( 2) falls No falls Falls (n = 80) 34 / 80 (43%) 21 / 33 (64%) 12 / 33 (36%) 1 patient who fell did not note how many falls 45/ 80 (56%) 1 non-respondent about falls p = Males Females Falls 16 / 29 (55%) 18 / 50 (36%) No falls 13 / 29 (45%) 32 / 50 (64%) 2 most common mechanism of falls: Turning the corner - 18 reports Uneven ground - 12 reports No statistical difference between falls and mean age, BMI, number of comorbidities, and no association with being taught to use the knee walker

9 Post-OperaAve Use of the Wheeled Knee-Walker aker Foot and Ankle Surgery Results Satisfaction (n = 80) Satisfied 68 / 80 (85%) Neutral 2 / 80 (2.5%) Dissatisfied 10 / 80 (12/5%) 31 / 34 (91%) respondents who fell were still satisfied with their KW

10 Discussion First study repor5ng on wheeled knee walkers in a clinical popula5on Weaknesses Low response rate Of 671 pa5ents who were given the op5on of using the knee walker and were mailed a survey, we were not able to retrospec5vely determine how many pa5ents actually used the knee walker, thus explaining the apparently low response rate (80 / 671, 12%). Retrospec5ve, recall bias

11 Discussion Due to the significant rate of falls (43%), pa5ents should be educated about the use and warned about the risks of falls when using a knee walker We are currently conduc5ng an ongoing prospec5ve study to examine knee walker use, adverse events, and the associa5on between adverse events and possible risk factors.

12 References 1. Crockard A. Orthopaedic Scooter. Br Med J (Clin Res Ed). 1986;292(6535): Kocher BK, Chalupa RL, Lopez DM, et al. ComparaWve Study of Assisted AmbulaWon and Perceived ExerWon With the Wheeled Knee Walker and Axillary Crutches in Healthy Subjects. Foot Ankle Int. 2016;37(11): Roberts P, Carnes S. The Orthopaedic Scooter. An energy-saving aid for assisted ambulawon. J Bone Joint Surg Br. 1990;72(4): Weston PM. Orthopaedic Scooter. Br Med J (Clin Res Ed) (6533):1460.