DEAR DOCTOR K:

I recently had a right hip replacement. My doctor says I'm ready to use a cane. What's the best way to use one?

DEAR READER:

A cane will get you on your feet and allow you to be more active. It will also help you strengthen your body and give you some independence while your hip heals.

First, it's important to make sure you select the right cane. There are several types: standard, offset and multi-leg (quad).

The standard cane has a curved handle or a T-shaped (functional grip) handle. A standard cane is good if you need help with balance but the cane doesn't have to bear a lot of weight.

An offset cane (the upper part of the shaft bends outward) can bear more weight than a standard cane. The handle is usually flat, which makes it a good choice if your hands are weak.

Multi-leg canes have three or four short legs branching from the main shaft. They offer the most support.

Try different handle designs to see which is easiest to grip and feels most comfortable when you walk. Avoid metal handles.

Make sure your cane is the right height. When you're standing straight and holding your cane upright, your elbow should be flexed at a 15- to 30-degree angle.

Walking with a cane takes practice. To start:

(1) Hold the cane in the hand opposite your affected hip (in your case, your left hand);

(2) Move the cane several inches ahead of you;

(3) Then move the leg that was operated on (your right leg) forward, about as far forward as the cane is, bearing some of your weight on the cane;

(4) Next, move the leg that was not operated on (your left leg) forward past the leg that was operated on.

(5) Start with Step 2 again.

I recall a patient of mine who, like you, had just undergone a hip replacement and had been given a cane. When I asked him how it was going, he said it worked pretty well at home, but that he couldn't go out. I was puzzled about why using the cane should be harder outside the home than in the home. It turned out that he was simply embarrassed to be seen in public using a cane. "Canes are for old people," he said.

So I taught him to use crutches. That way people might think he'd been skiing an expert trail in the Rockies! Since then, I've asked many of my patients facing hip or knee replacement surgery about their views on canes vs. crutches. A fair number (and not all of them men) much preferred the image of using crutches to using a cane. Both devices are fine for most patients. Choose whatever is best for your self-image. (For my hip replacement surgery, I used crutches.)

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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