Standard Crutches vs Rolling Knee Scooters: Analysis of Patient Satisfaction and Risk of Falling after Foot and Ankle Surgery
Authors: Solon Lorenzo , Winters Brian S. , Fuchs Daniel J. , O'Neil Joseph T. , Raikin Steven M. , Pedowitz David I. 
Published: November 2022

Category:

Other; Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

Rolling knee scooters and standard crutches are commonly used following foot and ankle surgery for patients who are required to keep weight off the extremity. In all non-weight bearing situations, muscle atrophy, lack of stability, and decreased blood flow increasing the risk of clots. Postoperative falls within 30 days after surgery have been shown to significantly increase morbidity and correlate directly with age. While it is known that falls following procedures are a definitive concern and should be guarded against, there is a deficiency in reporting with regards to the use of knee scooters and the commonality of falls in the postoperative period while using them in comparison to more traditional means of ambulatory aid like crutches.

Methods:

From June 2021 to February 2022, 120 patients were prospectively enrolled after foot and ankle procedures at a single institution that required a non-weight bearing period of at least 2-weeks. Patients completed surveys at each post-operative visit until they were weight-bearing asking them to report ambulatory aid device utilized, level of satisfaction, time using the device, number of falls, and complications. Patient demographics, including sex, age, BMI, smoking history, co-morbidities were retrospectively collected and analyzed using descriptive statistics (means, standard deviations, ranges). The relative incidence of a fall occurring was calculated among the entire cohort, with each separate fall counting individually. A regression analysis was performed to identify any patient factors associated with the occurrence of falls. T-tests will be performed to compare the relative chance of a postoperative fall or device-related complication between patients using rolling scooters and those using crutches and assess for significance (p<.05).

Results:

106 patients (59 female and 47 male) either used a rolling knee scooter or crutches. For 65 ankle procedures and 41 forefoot procedures, the average age was 51.6 +- 16.0, BMI was 28.6 +- 5.59. Regression analysis of all falls found that only age (p=0.058) was slightly, but not significantly associated with a greater fall risk. Demographic factors such as sex, BMI, procedure type (forefoot vs. hindfoot), and previous experience with the device were not associated with a greater fall risk (p>0.05). Patients were more likely to have used crutches for a previous injury compared to knee scooters (p=.006). Knee scooters were used significantly more often and had higher patient satisfaction compared to crutches (p=0.043, p=0.03). Patients using crutches reported a total of 22 falls compared to 14 total falls knee scooters (p=0.188). Overall, patients would rather use knee scooters than crutches for future foot and ankle surgeries (p=0.001).

Conclusion:

Both standard crutches and rolling knee scooters are safe and effective methods of non-weight bearing ambulatory aid after foot and ankle procedures. Older patients may be associated with a greater risk of falling regardless of ambulatory aid device utilized. Although there were no significant differences in number of falls between patients who used crutches vs. scooters, patients were significantly more satisfied with rolling knee scooters and more likely to use them in the future.