The influence of the crutch setup on stability and weight-bearing parameters in post total hip replacement surgery patients during quiet standing.

PURPOSE: The purpose of this study is to evaluate the influence of the crutch setup on standing, in post total hip replacement (THR) surgery patients. MATERIALS AND METHODS: Thirty patients after THR were randomly assigned to walking with the elbow flexed (EF) or elbow straight (ES) crutch setup. Subjects were asked to stand on a force platform in a comfortable position with the crutch positioned on the unaffected side, facing forward for 10 seconds. Centre of pressure total path and maximal excursion were evaluated in both medio-lateral and anterior-posterior planes. Difference in the asymmetry of left/right acromial height, measured with and without the crutch, was calculated (ACdiff). Percentage of body weight borne by the crutch (Fcr), symmetry (SIload) between operated and healthy limbs loading during the trial, together with shoulder forces and moments were measured. RESULTS: No significant differences between the two groups (p > .05) were found for stability parameters. ACdiff, Fcr and shoulder load increased significantly (p < .05) in EF group compared to ES group. In addition leg loading symmetry was significantly reduced in the EF group. CONCLUSIONS: The present study showed that the ES setup reduced the force borne by the crutch, the load on the shoulder joint and it minimized postural and loading asymmetries when compared to EF setup. Conversely, postural stability was not influenced by the crutch setup. Implications for Rehabilitation Static posture and weight-bearing parameters are influenced by crutch setup during quiet standing. Crutch setup does not influence postural stability. Adjusting the crutch according to the elbow straight setup reduces the force borne by the crutch and the asymmetry in lower limbs loading. Forces and moments at the shoulder joint were reduced for the elbow straight setup group.

Does crutch length influence gait parameters after total hip replacement surgery?

After total hip replacement surgery, crutches are often prescribed to enable patients to walk independently. Purpose of this study was to evaluate possible crutch length influence on gait performance and symmetry, including spatiotemporal and kinetics parameters. Thirty patients were randomly assigned to elbow flexed (EF) or elbow extended (EE) crutch setup. Subjects were asked to walk on the laboratory path, instrumented with motion tracking system and force platforms. Spatiotemporal gait parameters and ground reaction force (GRF) parameters for both limbs and crutch support were evaluated. In addition, limb symmetry was evaluated for both gait and force parameters using the symmetry index. Variability was quantified for base of support width, stride time and length as the coefficient of variation. Results showed that cadence and walking speed were not significantly different, but stride length significantly decreased and base of support width increased for the EF group when compared to the EE group. Operated limb GRF parameters were significantly decreased for the EF group, while crutch force parameters decreased for the EE group. Furthermore, the EF group showed greater stride length variability and asymmetry of force and spatiotemporal parameters than EE group did. The results of the present study showed that EF and EE setups did not assist patients equally during walking, with EE setup allowing more load bearing on the operated side, reducing load on the crutch and asymmetries in gait parameters when compared to the EF setup. This may help clinicians in rationalizing crutch setup for patients after total hip replacement surgery.