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Sadiq S, Noor R, Akram R. Risk factors of post discharge falls in patients undergoing total knee arthroplasty: An integrative review. J Back Musculoskelet Rehabil 2024:BMR230165. [PMID: 39031337 DOI: 10.3233/bmr-230165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a widely performed surgical procedure aimed at alleviating pain and restoring functionality in individuals suffering from knee osteoarthritis. Despite substantial benefits of TKA, patients are exposed to potential risks, including the occurrence of falls during their recovery period following discharge from the hospital. OBJECTIVE This integrative review endeavors to comprehensively investigate the existing body of literature to identify and assess the diverse factors that contribute to occurrence of post-discharge falls among TKA patients. Through the synthesis of available research, this study seeks to offer valuable insights that can guide clinical practices and interventions designed to mitigate the incidence of post-TKA falls, ultimately enhancing patient outcomes and quality of healthcare. METHODS An integrative review was conducted and databases were searched including Pubmed, PEDro, Cochrane, and SPORTDiscus from 2000 to 2024. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was performed using Newcastle-Ottawa Scale for Case Control and Cohort studies and AXIS tool for cross-sectional study. RESULTS Eleven articles finally met the inclusion criteria and were included in the review based on eligibility. There were 8 cohort studies (7 prospective cohorts, 1 retrospective cohort), 2 case control studies, and 1 cross-sectional study. The prospective cohort studies included in the review collected data in real-time as events occurred, making them particularly relevant for studying post-TKA falls. CONCLUSION Patients who underwent TKA are at risk of post-discharge falls. Several key risk factors have been identified, including advancing age, female gender, reduced proprioception, psychiatric disorders, living alone, and knee pain in the operated knee. It is important to recognize that the significance of these risk factors can vary depending on individual circumstances and contexts.
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Affiliation(s)
- Samreen Sadiq
- Department of Physical Therapy, Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Gulberg III Campus, Lahore, Pakistan
| | - Rabiya Noor
- Department of Physical Therapy, Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Gulberg III Campus, Lahore, Pakistan
| | - Rizwan Akram
- Orthopedic and Spine Department, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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Pop AM, Russu OM, Zuh SG, Feier AM, Pop TS. The Impact of Living Arrangements on the Prevalence of Falls after Total Joint Arthroplasty: A Comparison between Institutionalized and General Geriatric Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3409. [PMID: 36834101 PMCID: PMC9964882 DOI: 10.3390/ijerph20043409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Due to population aging, there is an increasing need for orthopedic surgery, especially total knee arthroplasty (TKA) and total hip arthroplasty (THA). In geriatric patients, postoperative falls are common events which can compromise the success of these expensive procedures. The aim of our study was to assess the influence of living arrangements on the prevalence of postoperative falls following joint replacement. We included 441 patients after TKA or THA, living in nursing homes, alone or with family. The prevalence of falls in the first 2 years (15.2%) was significantly influenced by living arrangements: patients with TKA or THA living alone had three times higher odds of falling compared to those living with family, and institutionalized patients with THA had four times higher odds of falling compared to those living with family. Of 67 patients who fell, 6 (8.9%) needed reintervention. For TKA patients, the fall rates were not significantly different between institutions and family, indicating the interest of nursing homes in offering proper care. However, for the THA group, the results were poorer, emphasizing the need for improvement in postoperative rehabilitation. Further multi-centric studies are required for generalizing the impact of living arrangements on fall prevalence after joint replacement.
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Affiliation(s)
- Anca Maria Pop
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
| | - Octav Marius Russu
- Department of Orthopedics and Traumatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- Clinic of Orthopedics and Traumatology, County Clinical Hospital Mureș, 540080 Târgu Mureș, Romania
| | - Sándor György Zuh
- Department of Orthopedics and Traumatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- Clinic of Orthopedics and Traumatology, County Clinical Hospital Mureș, 540080 Târgu Mureș, Romania
| | - Andrei Marian Feier
- Clinic of Orthopedics and Traumatology, County Clinical Hospital Mureș, 540080 Târgu Mureș, Romania
| | - Tudor Sorin Pop
- Department of Orthopedics and Traumatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- Clinic of Orthopedics and Traumatology, County Clinical Hospital Mureș, 540080 Târgu Mureș, Romania
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3
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Evaluation of the balance function before and after total knee arthroplasty using Berg balance scale. Arch Orthop Trauma Surg 2022; 142:3461-3467. [PMID: 34716485 DOI: 10.1007/s00402-021-04233-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate balance function before and after total knee arthroplasty (TKA) using Berg balance scale (BBS). The study also aimed to identify factors associated with balance impairment. MATERIALS AND METHODS Ninety-three knees in 90 patients were prospectively evaluated using their BBS scores, passive knee extension/flexion angles, Visual analogue scale for pain scores, hip-knee-ankle angles, and knee extensor/flexor muscle strengths before and after TKA. A total BBS score of less than 45 indicates an enhanced risk of multiple falls. Multivariate logistic regression models were performed to elucidate factors associated with post-operative BBS score. RESULTS A significant difference in mean pre- and post-operative BBS scores were noted (49.3 ± 6.4 vs. 52.2 ± 4.7) (p < 0.05). The percentage of pre- and post-operative BBS scores less than 45 were 20% and 10% (p < 0.05). Rheumatoid Arthritis (RA), lower pre-operative BBS score, and larger post-operative knee flexion contracture were significantly associated with lower post-operative BBS score (p < 0.01). The post-operative knee flexion contracture greater than 10° was significantly associated with substantially high odds of post-operative BBS scores less than 45 (Odds ratio 7.6; 95% confidential interval 1.69-34.17). CONCLUSIONS While TKA significantly improved BBS scores, 10% of the patients remained at a risk for multiple falls. RA, lower pre-operative BBS score, and post-operative knee flexion contracture greater than 10° retained balance impairment even after TKA.
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Tütüncüler E, Ök N, Güngör HR, Bayrak G, Şavkın R, Büker N. A comparison of balance and fall risk in patients with unilateral and bilateral total knee arthroplasty. J Back Musculoskelet Rehabil 2022; 35:1043-1051. [PMID: 35001874 DOI: 10.3233/bmr-210127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Static or dynamic postural control cannot be fully restored in patients with knee osteoarthritis, even after total knee arthroplasty (TKA), which may contribute to an increased risk of falls in the elderly. OBJECTIVE To evaluate balance and the fall risk before and after TKA in patients with bilateral knee osteoarthritis. Secondary outcomes were patient-reported and performance-based activity limitations. METHODS A total of 45 patients were separated into two groups as unilateral TKA (UTKA, n= 24) and bilateral TKA (BTKA, n= 21) groups. All the patients received standard postoperative physical therapy for 3 months. Balance and fall risk (Biodex Balance System SD), patient-reported and performance-based functionality (WOMAC, 30-second chair-stand test, 9-step stair climbing test and 40-meter fast-paced walk test) and Short Form-12 (SF-12) were evaluated at preoperatively, and at 3 months postoperatively. RESULTS There was no difference between the groups in postoperative fall risk and balance (p> 0.05). The BTKA group obtained better results in the sit-to-stand test and SF-12 physical dimension (p< 0.05). CONCLUSIONS UTKA and BTKA interventions and the standard postoperative rehabilitation were seen to improve balance and quality of life, and reduce the fall risk, patient-reported and performance-based activity limitations. However, despite improvements in balance, the risk of falling persists.
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Affiliation(s)
- Erman Tütüncüler
- Department of Orthopedics, State Hospital of Denizli, Denizli, Turkey
| | - Nusret Ök
- Department of Orthopedics and Traumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Harun Reşit Güngör
- Department of Orthopedics and Traumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gökhan Bayrak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muş Alparslan University, Muş, Turkey
| | - Raziye Şavkın
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Nihal Büker
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
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Fujita Y, Mera H, Watanabe T, Furutani K, Kondo HO, Wakai T, Kawashima H, Ogose A. Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks: a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty. BMC Musculoskelet Disord 2022; 23:768. [PMID: 35953812 PMCID: PMC9373377 DOI: 10.1186/s12891-022-05735-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 07/29/2022] [Indexed: 12/14/2022] Open
Abstract
Background Near-falls should be detected to prevent falls related to the earlier ambulation after Total knee arthroplasty (TKA). The quadriceps weakness with femoral nerve block (FNB) has led to a focus on adductor canal block (ACB). We purposed to examine the risk of falls and the earlier ambulation in each continuous infusion nerve block. Methods Continuous infusion nerve block (FNB or ACB) was performed until postoperative day (POD) 2 or 3. Pain levels and falls/near-falls with knee-buckling were monitored from POD 1 to POD 3. The score on the manual muscle test, MMT (0 to 5, 5 being normal), of the patients who could ambulate on POD 1, was investigated. Results A total of 73 TKA cases, 36 FNB and 37 ACB, met the inclusion criteria. No falls were noted. But episodes of near-falls with knee-buckling were witnessed in 14 (39%) cases in the FNB group and in 4 (11%) in the ACB group (p = 0.0068). In the ACB group, 81.1% of patients could ambulate with parallel bars on POD 1, while only 44.4% of FNB patients could do so (p = 0.0019). The quadriceps MMT values in the ACB group was 2.82, significantly higher than 1.97 in the FNB group (p = 0.0035). There were no significant differences in pain as measured with a numerical rating scale (NRS) and rescue analgesia through POD 3. Conclusion ACB was associated with significantly less knee-buckling and earlier ambulation post-TKA, with better quadriceps strength. Our study indicated the incidence of falls and near-falls with continuous infusion nerve blocks, and support the use of ACB to reduce the risk of falls after TKA. It is suggested that a certain number of the patients even with continuous ACB infusion should be considered with the effect of motor branch to prevent falls. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05735-6.
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Affiliation(s)
- Yutaka Fujita
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan.,Present Address: Department of Orthopedic Surgery, Nagaoka Chuo General Hospital, 2041, Kawasaki-machi, Nagaoka City, Niigata, 940-8653, Japan
| | - Hisashi Mera
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan.
| | - Tatsunori Watanabe
- Department of Anesthesiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Kenta Furutani
- Department of Anesthesiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan.,Present Address: Department of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 754, Ichibancho, Asahimachidori, Chuo-ku, Niigata, 951-8211, Japan
| | - Haruna O Kondo
- Division of Rehabilitation, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Takao Wakai
- Division of Rehabilitation, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 754, Ichibancho, Asahimachidori, Chuo-ku, Niigata, 951-8211, Japan
| | - Akira Ogose
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
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Masarwa R, Yonai Y, Paz I, Steinfeld Y, Ben Natan M, Berkovich Y. Falls among older patients with total knee arthroplasty. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Factors affecting short-term functional gain following total knee arthroplasty in patients aged from 75 years at a postacute rehabilitation setting. Int J Rehabil Res 2022; 45:260-266. [PMID: 35777929 DOI: 10.1097/mrr.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The intensive rehabilitation of older patients after total knee arthroplasty (TKA) is vital for short-term improvement in mobility and daily living activities. We aimed to investigate the effectiveness of multidisciplinary rehabilitation and assess the early postoperative predictors that are associated with functional gain in TKA patients aged from 75 years in a postacute care setting. This study included 190 patients following primary TKA who were admitted at the postacute rehabilitation hospital. The main outcome measures were the motor component of functional independence measure (M-FIM), M-FIM effectiveness, numerical rating scale, knee extension strength and range of motion, 10-m walk test, Berg balance scale (BBS), and mini-mental state examination (MMSE). The functional gain between patient age groups of ≥75 (n = 105) and <75 (n = 85) years were compared. Although patients aged ≥75 years showed lower improvement in BBS score compared with <75 years, the M-FIM gains and other physical functions were similar in both age groups. In multivariate analysis, the results for M-FIM at admission (β: -0.703; P = 0.001), BBS (β: 0.342; P = 0.032) and MMSE (β: 0.446; P = 0.021) were independently associated with functional gain in the patients following TKA aged ≥75 years. Multidisciplinary inpatient rehabilitation was beneficial for basic functional gain except for improvement in balance ability in patients after TKA aged ≥75 years. Functional level, balance ability and cognitive status in the early postoperative period can be useful predictors for short-term functional gain in the postacute care phase.
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Hill AM, Ross-Adjie G, McPhail SM, Jacques MBiostat A, Bulsara M, Cranfield A, Etherton-Beer C, Azlan Mn NR, Powell SJ, Hardisty G, Monterosso L. Incidence and Associated Risk Factors for Falls in Older Adults After Elective Total Knee Replacement Surgery: A Prospective Cohort Study. Am J Phys Med Rehabil 2022; 101:454-459. [PMID: 34292196 DOI: 10.1097/phm.0000000000001848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 mos after elective, primary total knee replacement surgery. DESIGN A prospective observational cohort of older adults undergoing total knee replacement were followed. Baseline measurements included risk factors of history of falls, using a gait aid and number of medications. Falls data were recorded after discharge for 12 mos alongside patient reported outcomes (Oxford Knee Score). Analyses used logistic and negative binomial regression modeling. RESULTS There were 267 participants (mean age = 70 [6.7] yrs) enrolled. Participants who fell (n = 102 [40.6%]) reported 200 falls in the 12 mos after surgery. The incidence of falls was 2.4 falls per 1000 patient days in the 12 mos after surgery, with the highest incidence (2.6 falls per 1000 patient days) in month 1. Risk factors for falling were a history of falls (adjusted odds ratio = 2.41, 95% confidence interval = 1.35-4.31) and number of central nervous system acting medications taken before surgery (adjusted odds ratio = 1.66, 95% confidence interval = 1.25-2.21). Using a walking aid at baseline was associated with falls after discharge (adjusted incident rate ratio = 2.38, 95% confidence interval = 1.57-3.60). CONCLUSIONS Older adults experience a high incidence of falls after elective total knee replacement. Further research that investigates falls prevention after total knee replacement is required.
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Affiliation(s)
- Anne-Marie Hill
- From the School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia (A-MH, AJ); Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia (A-MH, MB); School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Australia (GR-A, LM); Australian Centre for Health Services Innovation and Centre of Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia (SMM); Clinical Informatics Directorate, Metro South Health, Brisbane, Australia (SMM); Centre for Nursing and Midwifery Research, St John of God Hospital, Murdoch, Australia (AC, NRA, S-JP, LM); WA Centre for Health and Ageing, University of Western Australia, Perth, Australia (CE-B); Faculty of Health and Medical Sciences: Surgery, University of Western Australia, Perth, Australia (GH); Western Orthopaedic Clinic, St John of God Hospital Murdoch and Hollywood, Perth, Australia (GH); School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia (LM); and Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia (LM)
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Determination of Factors Affecting the Incidence of Falls, Fear of Falling, and Functional Status in Patients After Total Knee Arthroplasty. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1024664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Sargin S, Guler NS, Sahin N, Aslan A. Effects of total knee arthroplasty on balance and fall risk in elderly patients with severe gonarthrosis: An age- and sex-matched comparative study. Niger J Clin Pract 2022; 25:1445-1451. [DOI: 10.4103/njcp.njcp_1856_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Taniguchi M, Sawano S, Maegawa S, Ikezoe T, Ichihashi N. Physical Activity Mediates the Relationship between Gait Function and Fall Incidence after Total Knee Arthroplasty. J Knee Surg 2021; 34:1205-1211. [PMID: 32131104 DOI: 10.1055/s-0040-1702165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The present study aims to examine (1) the preoperative factors that can predict postoperative falls, (2) whether postoperative physical activity (PA) mediates the relationship between fall incidence and gait function, and (3) whether postoperative PA levels are associated with fall risk in total knee arthroplasty (TKA) patients. Ninety-six patients (mean age: 72.0 ± 6.1 years) who were observed postoperatively for 6 months were selected. Timed up and go (TUG) was assessed as an indicator of gait function. Fall incidence and PA were investigated for 6 months post-TKA. The body mass index, history of preoperative falls, knee pain, knee extensor strength, range of motion in knee flexion, and modified gait efficacy scale were evaluated. Additionally, postoperative PA levels were categorized into three groups-low: <3,000, moderate: 3,000 to 4,000, and high: ≥4,000 steps/day. The relative fall incidence rate was calculated according to the total number of falls normalized for every 1,000 steps/day for 6 months postoperatively. Twenty-five (26.0%) of the 96 patients had at least one fall. The TUG, knee pain, and knee extensor strength were identified preoperatively as significant variables affecting postoperative falls. The mediated effects model revealed that postoperative fall incidence was predicted by preoperative TUG and postoperative PA. Postoperative PA was significantly associated with preoperative TUG. Moreover, both the preoperative TUG and postoperative PA were selected as significant variables for predicting fall incidence. Thus, postoperative PA mediates the relationship between gait function and fall incidence after TKA. Furthermore, the relative fall incidence rate associated with a low PA level was significantly higher than that associated with moderate and high PA levels. In conclusion, preoperative assessments of TUG performance, muscle strength, and knee pain were effective in predicting fall risk. Additionally, an increase in PA could contribute to reducing fall risk in TKA patients. Therefore, our results suggest that preoperative screening for fall predictors and managing postoperative PA could reduce the fall incidence in TKA patients.
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Affiliation(s)
- Masashi Taniguchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Shinichiro Sawano
- Rehabilitation Units, Shiga University of Medical Science Hospital, Tsukinowa-cho, Seta, Otsu City, Shiga, Japan
| | - Shoji Maegawa
- Rehabilitation Units, Shiga University of Medical Science Hospital, Tsukinowa-cho, Seta, Otsu City, Shiga, Japan
| | - Tome Ikezoe
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
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12
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de Lima F, Melo G, Fernandes DA, Santos GM, Rosa Neto F. Effects of total knee arthroplasty for primary knee osteoarthritis on postural balance: A systematic review. Gait Posture 2021; 89:139-160. [PMID: 34284334 DOI: 10.1016/j.gaitpost.2021.04.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis is often related to physical function impairment. Although total knee arthroplasty is considered effective for advanced cases of knee osteoarthritis, its effects on postural balance is a topic of debate. RESEARCH QUESTION What are the effects of total knee arthroplasty for primary knee osteoarthritis on postural balance compared to preoperative status and/or to healthy controls?. METHODS Longitudinal studies (with more than 1-month follow-up) assessing postural balance measures (either clinical-based such as balance scales or laboratory-based such as postural sway) were considered eligible and selected in a 2-phase process. Six main electronic databases were searched, complemented by 3 grey literature sources. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS A total of 19 studies were included for qualitative synthesis, of which 14 had low and 5 had a moderate risk of bias. The follow-up period ranged from 1-24 months. Most studies (n = 11) presented comparisons to preoperative status only. From these, 7 studies reported relevant improvements in postural balance, 2 reported partial improvements, and 2 no improvements. The remaining studies (n = 8) presented comparisons to healthy controls and, although improvements following total knee arthroplasty were consistently observed, only one study reported postural balance measures comparable to that of controls. CONCLUSIONS The majority of studies reported relevant improvements (especially in clinical-based measures) compared to preoperative evaluations, although inconsistencies were found possibly due to variability in studies' populations, assessment tools, and follow-up times. Despite this, persistent deficits in postural balance were commonly observed when compared to healthy controls. SIGNIFICANCE This evidence synthesis could better inform clinicians and researchers about the therapeutic effects and limitations of total knee arthroplasty concerning postural balance. Standardization of assessment tools is recommended to strengthen the certainty of cumulative evidence.
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Affiliation(s)
- Fernando de Lima
- Postgraduate Program in Human Movement Sciences, State University of Santa Catarina (UDESC), Florianópolis, Santa Catarina (UDESC), Brazil.
| | - Gilberto Melo
- Postgraduate Program in Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.
| | - Daniel Araujo Fernandes
- Department of Surgery and Postgraduate Program in Medical Sciences (PPGCM), Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.
| | - Gilmar Moraes Santos
- Centre of Health and Sports Sciences (CEFID), State University of Santa Catarina, Florianópolis, Santa Catarina (UDESC), Brazil.
| | - Francisco Rosa Neto
- Centre of Health and Sports Sciences (CEFID), State University of Santa Catarina, Florianópolis, Santa Catarina (UDESC), Brazil.
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Tsubosaka M, Muratsu H, Nakano N, Kamenaga T, Kuroda Y, Miya H, Kuroda R, Matsumoto T. Sequential changes in lower extremity function after total knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 28:2309499020965645. [PMID: 33231121 DOI: 10.1177/2309499020965645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The effectiveness of total knee arthroplasty (TKA) for recovering ambulation and balance functions has not been investigated in detail. The present study aimed to measure functional changes in the lower limb before and after TKA by measuring ambulation function with the 3 m Timed Up and Go (TUG) test and balance function using one-leg standing time (ST). METHODS The study included 137 patients (116 women and 21 men) with osteoarthritis of the knee who underwent primary TKA. The mean age of the patients was 74.4 years. The mean postoperative hospital stay for rehabilitation was 23.9 days. The TUG test and ST were performed preoperatively, 2 weeks postoperatively, at discharge, and 3, 6, and 12 months postoperatively. These results from these six measurements were also compared using one-way repeated measures analysis of variance. RESULTS The TUG test and ST were significantly improved at 3 months after surgery. However, both the TUG test and ST did not improve further from 3 months to 6 months postoperatively or from 6 months to 1 year postoperatively. CONCLUSION TKA is useful for restoring lower limb function, as both ambulation and balance functions were significantly improved 3 months after surgery. However, no further improvement in ambulation or balance function was recognized beyond 3 months.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopaedic Surgery, 38303Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.,Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Yumesaki-chou, Hirohata-ku, Himeji, Hyogo, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Yumesaki-chou, Hirohata-ku, Himeji, Hyogo, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, 38303Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, 38303Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, 38303Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Hidetoshi Miya
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Yumesaki-chou, Hirohata-ku, Himeji, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, 38303Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, 38303Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
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Analysis of the Associations between Arthritis and Fall Histories in Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073758. [PMID: 33916869 PMCID: PMC8038444 DOI: 10.3390/ijerph18073758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 01/07/2023]
Abstract
(1) Background: the purpose of the present study was to analyze the associations between arthritis and fall histories in Korean adults. (2) Methods: data from the 2015 and 2017 Korean Community Health Survey were analyzed. In total, 322,962 participants aged ≥40 years were included. The participants were divided into two different groups. First, the participants were divided into the ‘arthritis (osteoarthritis or rheumatoid arthritis) for entire life’ and ‘nonarthritis for entire life (comparison I)’ groups. Subsequently, the participants were divided into the ‘current arthritis’ and ‘noncurrent arthritis (comparison II)’ groups. Afterwards, we analyzed the prevalence odds ratios (pORs) of the fall histories of the participants using a logistic regression analysis with the 95% confidence interval (CI). The variables of income, education level, region of residence, smoking status, alcohol consumption, obesity, subjective health status, stress level, physical activity, and sleep hours were adjusted for as covariates. (3) Results: both the arthritis for entire life and current arthritis groups had higher prevalence rates of falls than the comparison I and comparison II groups, respectively (each p < 0.001). The pORs of falling ≥1 time and ≥2 times per year in the arthritis for the entire life group were 1.42 (95% CI = 1.38–1.46) and 1.69 (95% CI = 1.62–1.76), respectively. The adjusted pORs for falling ≥1 time and ≥2 times per year in the current arthritis group were 1.35 (95% CI = 1.31–1.39) and 1.56 (95% CI = 1.50–1.63), respectively. (4) Conclusions: previous arthritis has a significant impact on the risk of falling.
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Amano T, Tamari K, Suzuki N. Cross-Validation of a Screening Tool to Distinguish Between Fallers and Nonfallers in Community-Dwelling Older Adults With Knee Osteoarthritis. Arch Phys Med Rehabil 2020; 102:598-603. [PMID: 33309679 DOI: 10.1016/j.apmr.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/05/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aimed to cross-validate a previously developed knee osteoarthritis falls (KOAF) screening tool to distinguish between fallers and nonfallers among community-dwelling older adults with knee osteoarthritis (OA). DESIGN Cross-sectional survey study. SETTING Three independent orthopedic clinics. PARTICIPANTS Older outpatients with knee OA (N=86; 71 women, 15 men; mean age, 75.2±6.2y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome was to identify fallers and nonfallers among outpatients with OA based on their history of falls within the past year. We investigated factors including sex, age, body mass index, Kellgren-Lawrence grade, affected side (bilateral or unilateral knee OA), number of comorbidities, pharmacotherapy, physical therapy, pain, and activity as individual predictors of falls. Participants performed the one-leg standing test and the 5 times sit-to-stand test to determine motor function. Sensitivity, specificity, likelihood ratio, and post-test probability of the KOAF screening tool were calculated using receiver operating characteristic (ROC) curve analysis. RESULTS The results of the one-leg standing test and 5 times sit-to-stand test differed significantly between the 2 groups (P<.05). ROC curve analysis showed that the area under the curve was 0.88 (95% confidence interval, 0.80-0.96; P<.001). The post-test probability of falls was 83.3% (positive likelihood ratio, 11.54) when the total score of KOAF screening tool was 2 points and 2.6% (negative likelihood ratio, 0.06) when the total score of KOAF screening tool was less than 1 point. CONCLUSIONS Cross-validation results for the KOAF screening tool were better, confirming that the screening tool could distinguish between fallers and nonfallers with high accuracy. Our findings suggest that this simple screening tool could be readily used in clinical practice and could aid in clinical decision-making through providing choices for physical therapy evaluation and recommendations for physical therapy programs.
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Affiliation(s)
- Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Shizuoka, Japan.
| | - Kotaro Tamari
- Department of Physical Therapy, Faculty of Health and Medical Science, Teikyo Heisei University, Toshima, Tokyo, Japan
| | - Nobuharu Suzuki
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Shizuoka, Japan
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16
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Barbosa IM, de Sousa TG, Fernandes LM, Campos JSM, Nogueira JBS, Bezerra MJC. Mind Health Before and After Total Knee Arthroplasty. Rev Bras Ortop 2020; 55:783-786. [PMID: 33364660 PMCID: PMC7748925 DOI: 10.1055/s-0040-1708519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/20/2019] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the preoperative and postoperative outcomes of patients diagnosed with severe knee osteoarthritis who underwent a total knee arthroplasty (TKA) using a mobile-bearing implant with a rotating platform and removing the posterior cruciate ligament. The present study focused on the outcomes relative to depression, pain, functional limitations, and fall episodes. Methods The Lequesne questionnaire was used to assess pain and functional limitations before and after TKA. In addition, the geriatric depression scale (GDS) was also used. Episodes of falls before and after the surgery were estimated. Results The mean Lequesne score before the surgery was 15.95, and that after surgery was 6.5. This finding was statistically significant ( p < 0.001). The mean GDS score before the surgery was 7.43, and that after TKA was 2.22 ( p < 0.001). The mean number of fall occurrences before the procedure, over a 1-year period, was 1.22, and that after TKA was 0.27 ( p = 0.004). A direct relationship was found between the Lequesne scores before the surgery and the GDS scores ( p = 0.004). Conclusions Total knee arthroplasty resulted in the improvement of pain and functional limitation, decrease or disappearance of the depressive condition, and decrease of fall rates in the evaluated patients.
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Affiliation(s)
| | | | | | | | | | - Marcelo José Cortez Bezerra
- Departamento de Ortopedia, Santa Casa da Misericórdia de Fortaleza, Fortaleza, CE, Brasil
- Departamento de Ortopedia, Universidade Unifor, Fortaleza, CE, Brasil
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17
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Jette DU, Hunter SJ, Burkett L, Langham B, Logerstedt DS, Piuzzi NS, Poirier NM, Radach LJL, Ritter JE, Scalzitti DA, Stevens-Lapsley JE, Tompkins J, Zeni Jr J. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther 2020; 100:1603-1631. [PMID: 32542403 PMCID: PMC7462050 DOI: 10.1093/ptj/pzaa099] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/24/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.
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Affiliation(s)
- Diane U Jette
- FAPTA, MGH, Institute of Health Professions, Boston, Massachusetts
| | | | - Lynn Burkett
- ONC, National Association of Orthopaedic Nurses (NAON), Wyomissing, Pennsylvania
| | - Bud Langham
- Home Health and Hospice Services, Encompass Health, Birmingham, Alabama
| | - David S Logerstedt
- Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Noreen M Poirier
- Department of Orthopedics and Rehabilitation, University of Wisconsin (UW) Health, Madison, Wisconsin
| | - Linda J L Radach
- Consumers United for Evidence Based Healthcare, Lake Forest Park, Washington
| | - Jennifer E Ritter
- Department of Rehabilitation Services/Physical Therapy, University of Pittsburgh Medical Center (UPMC) St Margaret Hospital/Catholic Relief Services, Pittsburgh, Pennsylvania
| | - David A Scalzitti
- OCS, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado at Denver & Health Sciences Center, Denver, Colorado
| | - James Tompkins
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona
| | - Joseph Zeni Jr
- Department of Physical Therapy, University of Delaware, Newark, Delaware
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18
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Sridharan MJ, Everhart JS, Frantz TL, Samade R, Neviaser AS, Bishop JY, Cvetanovich GL. High prevalence of outpatient falls following elective shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:699-706. [PMID: 32088078 DOI: 10.1016/j.jse.2019.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/04/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study characterized the prevalence and risk factors of inpatient and outpatient postoperative falls in patients undergoing elective shoulder arthroplasty. METHODS A retrospective chart review of 198 patients undergoing anatomic or reverse total shoulder arthroplasty or hemiarthroplasties at one institution between 2015 and 2017 was reviewed to determine the prevalence of inpatient and outpatient falls up to 90 days after discharge. Univariate and multivariate analyses were conducted to assess potential risk factors for postoperative falls including demographics, indication for surgery, surgical procedure, medical history, length of hospital stay, perioperative hemoglobin, need for transfusion, and discharge disposition. RESULTS There were 23 falls in 22 patients within a 90-day postoperative period. The inpatient fall rate was 1.0% (2 of 198). The outpatient fall rate was 10.6% (21 of 198). Outpatient falls resulted in emergency department evaluation in 23.8% of cases (5 of 21), readmission in 19.0% (4 of 21), injury to an anatomic site other than the shoulder in 19.0% (4 of 21), and injury at the surgical site (eg, periprosthetic humeral fracture) in 4.8% (1 of 21). No significant risk factors were identified for inpatient falls. Independent risk factors for an outpatient fall were female sex (adjusted odds ratio [aOR] = 4.79; 95% confidence interval [CI]: 1.32, 17.4; P = .007), increased length of hospital stay (aOR = 1.23; 95% CI: 1.04, 1.45; P = .02), and history of a movement disorder (aOR = 7.20; 95% CI: 1.22, 42.6; P = .03). CONCLUSION A high outpatient fall rate of 10.6% within 90 days after discharge raises the concern that falls after shoulder arthroplasty are significantly higher than previously reported.
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Affiliation(s)
- Mathangi J Sridharan
- Sports Medicine Research Institute, The Ohio State University, Columbus, OH, USA
| | - Joshua S Everhart
- Sports Medicine Research Institute, The Ohio State University, Columbus, OH, USA
| | - Travis L Frantz
- Sports Medicine Research Institute, The Ohio State University, Columbus, OH, USA
| | - Richard Samade
- Sports Medicine Research Institute, The Ohio State University, Columbus, OH, USA
| | - Andrew S Neviaser
- Sports Medicine Research Institute, The Ohio State University, Columbus, OH, USA
| | - Julie Y Bishop
- Sports Medicine Research Institute, The Ohio State University, Columbus, OH, USA
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Risk factors for falls in patients with total hip arthroplasty and total knee arthroplasty: a systematic review and meta-analysis. Osteoarthritis Cartilage 2019; 27:979-993. [PMID: 31028883 DOI: 10.1016/j.joca.2019.04.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/04/2019] [Accepted: 04/11/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Falls are common after total hip arthroplasty (THA) and total knee arthroplasty (TKA). While previous studies have investigated various risk factors for falls in patients following THA and TKA, no systematic reviews have summarized these risk factors. Therefore, the current systematic review aimed to summarize evidence regarding risk factors for falls in patients after THA and/or TKA. METHODS MEDLINE, EMBASE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (from inception to June 30, 2018) were searched. The methodological quality and quality of evidence of the included studies were assessed by two independent reviewers. Relevant data regarding participants' characteristics, study design, follow-up time points, and identified risk factors were extracted. Meta-analyses and narrative syntheses were performed. RESULTS Twelve studies with a total of 1,292,689 participants were included. Twenty-nine identified risk factors for post-THA/TKA falls were classified into either inpatient or post-discharge risk factors. Key risk factors for both post-THA and/or post-TKA inpatient falls that showed moderate level of evidence included: postoperative complications or comorbidities and revision THA/TKA. Likewise, risk factors for post-discharge falls after THA and/or TKA that demonstrated moderate level of evidence included: medications, psychiatric diseases, living alone, prior history of TKA, falls history and female gender. The quality of the included studies varied and sample sizes were not justified. CONCLUSIONS This review summarized both non-modifiable and modifiable risk factors for post-THA/TKA falls. Our findings highlight the importance of developing strategies to lower the falls risk among patients following THA/TKA.
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