The impact of assistive device prescription on gait following total knee replacement

To determine whether patients using a wheeled walker post-total knee replacement (TKR) surgery walk differently prior to hospital discharge and 6 weeks after surgery when compared with patients using a standard walker.

Fifty-one patients, mean age 67.2 (8.3), seen for TKR were assigned to either a standard walker group (n=23) or front-wheeled walker group (n=28). Most participants were assigned to a walker group on the basis of the type of walker procured in anticipation of the surgery; however, those without a walker were randomly assigned to a group. All participants received postoperative physical therapy consisting of a standardized protocol of exercises and gait training twice a day with the assigned walker. Step length, cadence, gait velocity, step length differential, and walking endurance were measured at discharge from the acute care setting and at 6 weeks following surgery.

At discharge from the acute care setting, the gait of the 2 groups was similar, with the exception of faster velocity and a longer step length on the noninvolved lower extremity for the wheeled walker group. Six weeks after surgery, both groups walked with faster velocity, longer step lengths, and faster cadence, with no differences between groups for walking endurance, perceived exertion, fall occurrence after surgery, functional scores, or days necessary to graduate from walker use.

The use of a front wheeled walker can facilitate greater velocity and longer step lengths in the immediate days following TKR than the use of a standard walker. However, this study provides no evidence that participants using wheeled walkers require fewer inpatient therapy sessions or have greater long-term gains in ambulation speed or quality. This study suggests that both types of walkers can safely be used for ambulation after TKR surgery.