Canes

Canes have been used since antiquity for lower extremity orthopaedic disorders. With that in mind, only a small number of modern studies have formally investigated use of a cane for knee osteoarthritis. Our literature review found one high quality study (Jones 2012) showing support for use regarding moderate pain relief and another study (Van Ginckel 2019) of moderate quality showing no major improvement in pain.

Jones 2012 performed a comprehensive study of use of a cane for knee osteoarthritis. Their primary outcome was pain, but they also looked at function, general health, consumption of NSAIDs and energy expenditure. 64 patients were selected out a total of 323 patients nominated from a rheumatology clinic. The majority of possible patients (168 out of 323) refused to participate in the study. 32 patients were randomized to use of a cane for 60 days (EG, experimental group). The cane was cut to appropriate height and they received instructions on its use. The 32 control patients (CG) were instructed to maintain normal lifestyle and not to use auxiliary gait devices. At 30 and 60 days the EG patients had less pain compared to controls. The greatest improvement was in the VAS (10 cm scale): EG averaging 3.84 cm and CG 5.95 cm at 60 days). The Lequesne scale (0-24) difference was only 2.53 (CG 15.09 and EG 12.56 at 60 days). At 60 days, the study group consumed fewer NSAIDs than control.

Van Ginckel 2019 evaluated use of a cane in patients with medial compartment knee osteoarthritis and bone marrow lesions (BML) on MRI. The primary intent of their study was to identify an effect on the size of BML by using a cane. Out of 1989 potential patients (contacted by phone or online) 231 were considered eligible for radiographic screening and of those, only 79 showed arthritic changes on plain films and BML on MRI and chose to continue with the study. 40 patients were assigned to use a cane whenever walking for the next 12 weeks. 39 control patients were instructed to maintain their usual lifestyle without any gait aids. Only one patient in the control group was lost to follow up. After 3 months there was no significant improvement in BML size. Secondary information was obtained relative to clinical characteristics. There was no significant difference between the two groups with regards to knee pain (WOMAC scale) or quality of life (AQoL 6-D scale) although there was improvement in global knee pain in the group using the cane.

Benefits/Harms of Implementation
Jones 2012 addressed the increased oxygen demand for ambulation using a cane. Initially all patients had decreased ambulation distance with a cane and increased heart rate and increased oxygen consumption.bAfter 60 days patients who had been using the cane (EG) were able to ambulate a similar distance with or without the cane suggesting an ability to adapt to the cane. Also, EG patients using the cane had more normal oxygen consumption after walking again suggesting physiologic adaptation to the cane with time.

Outcome Importance
Our review shows moderate confirmation that canes can relieve the pain of knee arthritis and improve function in those patients.

Cost Effectiveness/Resource Utilization
Use of a cane is a common low-cost treatment which is readily available with many options and typically covered by third party payers.

Acceptability
Van Ginckel noted “patient vanity” as a common reason for non-compliance. 

Feasibility
Canes have been used since antiquity although comparison studies are only being produced in the last generation. There is little downside to extended use of the cane as patients appear to adapt to the increased oxygen consumption demands.

Future Research
More studies would be beneficial to the knowledge base confirming value to patients with knee osteoarthritis.