Pre-Op Patient Education: How to Reduce Crutch-Related Callbacks

The Crutches.com Team · 7 min read
Physical therapist assisting a patient with in-Motion underarm crutches.

Every orthopedic practice has a callback log. The calls don't make headlines: "My shoulders are killing me." "When can I shower?" "How do I go up the stairs?" "Is it normal that my hands are numb?" "Can I take the boot off to sleep?"

They're routine, predictable, and almost universally avoidable.

They're also expensive. Every callback costs clinical staff time. Every avoidable office visit burns an appointment slot that could have gone to a new consult. Every escalation, a fall, a re-rupture, a wound complication, a DVT call to the ER, represents a patient who left for home without the information they needed to get through the first weeks safely.

The single highest-return intervention for reducing post-op call volume isn't a new app, a new portal, or a new staffing model. It's pre-op education. There is real evidence behind that: a randomized trial of preoperative education before total joint replacement found that patients who received structured education had significantly lower anxiety at admission and were more likely to be discharged home rather than to inpatient rehab (McDonald et al., Cochrane review of preoperative education for hip or knee replacement).

This post is for clinicians, surgery center coordinators, and PTs who are designing or refining their pre-op education process. It covers the crutch-related callback categories that pre-op education most reliably reduces, the topics that actually move the needle, and a practical framework for fitting updated patient education into existing pre-op workflows.

Why Crutch-Related Callbacks Are an Undertreated KPI

Most orthopedic practices track surgical volume, complication rates, and patient satisfaction scores. Few track post-op call volume systematically, and even fewer break it down by call category. But call volume is one of the cleanest leading indicators of how well pre-op education is working.

The call categories practices report in the first six weeks after lower-extremity orthopedic surgery cluster into a predictable pattern:

  • Crutch fitting and use, height adjustment, hand grip placement, shoulder pain, wrist pain, hand numbness
  • Mobility technique, stair use, getting in and out of bed, getting in and out of cars, transferring on and off toilets
  • Boot, brace, or splint compliance questions, when to wear, when to remove, sleeping protocols, showering protocols
  • Weight-bearing protocol clarification, NWB vs. TDWB vs. PWB vs. WBAT, and what each actually means at home
  • Driving and return-to-work questions
  • Pain management questions that should have been in the discharge packet
  • Falls, near-falls, and general fall-risk anxiety
  • When to call vs. when to wait

Every one of those categories is addressable through pre-op education, and most of them are addressable cheaply.

What Pre-Op Education Most Reliably Reduces Callbacks About

Not all pre-op education is equally effective. The topics with the most operational value share three things: they're concrete rather than abstract, they're visual or demonstration-based rather than text-only, and they're reinforced across multiple touchpoints rather than delivered once and forgotten.

1. Crutch Fitting and Basic Use Technique

The single largest source of crutch-related callbacks is patients using poorly-fit crutches incorrectly. Hand grip too high or too low. Underarm pads bearing weight that should be supported by the hands. Stride length that's too short or too long. Standard fitting guidance is specific: for underarm crutches, leave roughly two finger widths between the axilla and the pad, with about 30 degrees of elbow flexion at the handgrip; for forearm crutches, the cuff sits about 1.5 inches below the elbow. A 60-second video, a printed handout with diagrams, and a brief in-person demonstration at the pre-op visit take the volume out of "my shoulders hurt" and "my hands are numb" calls in week one.

2. Stair Technique

"Up with the good, down with the bad." Patients who learn this before surgery, ideally with a brief practical demo, handle stairs more safely and call less often. Stair-related falls are among the highest-stakes complications of those first weeks at home. It's a simple phrase. It's worth repeating until it sticks.

3. Concrete Weight-Bearing Language

Patients routinely conflate non-weight-bearing (NWB), touch-down weight-bearing (TDWB), partial weight-bearing (PWB), and weight-bearing as tolerated (WBAT). Each is a different prescription with different practical implications. Plain-language explanations work better than acronyms. "TDWB means as much weight as a postage stamp, just for balance" is something a patient can hold onto. The clinical shorthand is not.

4. Home Setup Before Surgery, Not After

Patients who arrive home to a recliner, raised toilet seat, shower chair, cleared pathways, and pre-cooked meals fall less, call less, and recover more comfortably. A pre-op handout listing the specific home modifications that matter for their procedure, not a generic "prepare your home" blurb, is one of the most valuable pieces of patient education a practice can produce. And it costs almost nothing to create.

5. The First 72 Hours

Most calls in the first three days are predictable: pain management questions, swelling concerns, nausea, when to take the next dose, how to ice. A short, dated post-op timeline, "Hours 0 to 12, 12 to 24, Day 2, Day 3", given to the patient before surgery tells them what to expect at each stage. It doesn't eliminate all calls. But it takes the edge off the "is this normal?" volume.

6. When to Call vs. When to Wait

Patients call the office for two reasons: they're worried, or they want permission to do something. A clear "call the office immediately if…" list handles the first. A "you don't need to call us about…" list handles the second. Together, they reduce inbound call volume without any reduction in clinical safety. Both lists should be visible, not buried at the back of a packet nobody reads past page two.

A Practical Pre-Op Education Framework

The most effective pre-op education is spread across multiple touchpoints rather than crammed into one appointment. Most of what a patient absorbs at the pre-op visit is competing with anxiety about the surgery itself, which is exactly why repetition across formats works better than a single verbal briefing.

Two weeks before surgery:

  • Mailed or emailed packet with a procedure-specific recovery timeline, a home setup checklist, and links to patient education content
  • Optional: a short pre-op video (5 to 10 minutes) covering crutch use, stair technique, home setup, and what to expect in the first 72 hours

At the pre-op visit:

  • Brief in-person crutch demonstration, fit them, hand them the crutches, watch them take ten steps
  • Stair technique demonstration if a model is available
  • Hand the patient a one-page "first 72 hours" timeline to take home
  • Confirm they have a ride and someone with them for the first 24 to 48 hours

Day of surgery and discharge:

  • Discharge packet with the same materials they've already seen, this is reinforcement, not first exposure
  • A clearly visible "call the office if…" list at the top of the packet
  • Phone number and after-hours protocol on every page, not just the back

Post-op follow-up call (24 to 48 hours):

  • A brief structured call from a nurse or coordinator: pain level, are they using the crutches correctly, are they following the weight-bearing protocol, any questions
  • This one call captures a large share of the questions that would otherwise become inbound calls on days 3 through 7

The Crutches Themselves Are a Callback-Reduction Lever

A meaningful share of "crutch-related" callbacks aren't about technique at all. They're about the crutches. Patients calling about shoulder strain, hand numbness, wrist pain, or upper-body fatigue in weeks two or three often aren't doing anything wrong. They're using standard underarm crutches, and the load is real: instrumented gait analysis puts peak axial crutch force at roughly 45 percent of body weight per crutch in reciprocal gait and about 57 percent in swing-through (Slavens et al., Gait & Posture, 2007). Pressure in the axilla can compress the brachial plexus and radial nerve, which is what produces the classic crutch palsy presentation of hand and wrist weakness.

This is most relevant for surgeries with longer crutch windows: meniscus repair, foot and ankle, ACL with concurrent meniscus, and Achilles repair. A patient facing weeks of daily crutch use can develop secondary upper-limb symptoms well before the leg is ready, and those symptoms are a common reason patients break protocol and start hopping or weight-bearing prematurely. Which is when you get the call you really don't want.

The In-Motion Pro forearm crutch is built around that cumulative-load problem: molded V-shaped forearm cuffs that spread contact across the forearm, angled and contoured grips that hold the wrist in a natural position, a spring-assist lower post that absorbs impact at ground strike, 1.8 lbs per crutch, and a 350 lb capacity. Both standard and large cuff sets ship in the box. For practices that see measurable post-op call volume from crutch-related secondary symptoms, the equipment itself is an operational lever, not just a product decision.

Learn more about clinician partnerships and the In-Motion crutch

Patient-Facing Resources You Can Use

We've published a surgery recovery hub, patient-facing guides built to support pre-op education across the surgeries with the most demanding crutch phases. Each covers realistic timelines, weight-bearing protocols, home setup, when to call, and the decisions that determine whether the recovery goes well. They're written for patients but designed to be share-ready as part of your pre-op education materials.

The Bottom Line

Crutch-related callbacks are not a fixed cost of orthopedic practice. They're a measurable signal of the gap between what patients know going into surgery and what they actually need to know once they're home.

The practices with the lowest call volumes aren't the ones with the most stoic patients. They're the ones with the most thorough, repeated, concrete pre-op education.

A pre-op education process built around the categories above, crutch fitting, stair technique, weight-bearing language, home setup, the first 72 hours, when to call, closes the gap the calls are coming from. The patients are clearer on what to expect, the staff gets fewer interruptions, and the protocols actually get followed.

The investment is small relative to the return. And it's one of the few areas in orthopedic operations where doing the right thing for patients and doing the right thing for the practice point in exactly the same direction.

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