INVESTİGATİON OF LONG TERM FALL PREVALENCE AFTER TOTAL KNEE ARTHROPLASTY İN HATAY: A CROSS-SECTİONAL STUDY

Abstract

Introduction: Falls and fractures caused by falls in the elderly affect their daily activities, creating fear of movement and alienating the individual from social participation. Fall related-injuries are some of the main afraid complications after total knee arthroplasty surgery. The aim of this study is to determine the incidence of falling and fear of movement in the long period (one year and more after surgery) in patients who had total knee arthroplasty surgery Materials and Methods: Patients who had total knee arthroplasty surgery in Hatay Mustafa Kemal University Department of Orthopedics and Traumatology between 01.01.2016 and 01.10.2020 enrolled in the study. Demographic information was recorded from the patient file or asked the patients/caregivers via telemedicine. The falls before the surgery, falls after the surgery within 3 months, within 3 to 6 months, within 6 to 12 months which caregiver/relatives remember recorded via telemedicine. Fear of movement assessed with the Tampa Kinesiophobia Scale was asked. Results: 149 Patients with, mean age 67.06±8.72 years, female (85,9%), mostly housewives (80,5%) was the cohort. Their education time (89,8 %) were less than 5 years, and the huge majority of the patients did not have exercise habits (83,2%). The fall rate before the surgery was (35,6%), after the surgery was (36,9%), within the first 3 months (6,7%), 3 to 6 months (6%) and 6 to 12 months (11,7%). 7, 4 % of our patients had a fall related-fractures including: 2 radius distal fractures (1.3%), 3 hip fractures (2%), 3 periprosthetic fractures (2%), 1 patella fracture (0, 7%) and 2 vertebral compression fractures (1.3%). Tampa Kinesiophobia Scale score was 41(38-44). There was a positive correlation between kinesiofobia and those who did not have exercise habits and those who fell preoperatively (p:0.01 r: 0.31, ). Conclusion: Some TKA patients were falling and had fear of movement. New researches should be conducted about what is the reason that makes the patients posture and movement more stable or which mechanism alters the balance. In order to prevent complications that may occur due to falls, new studies, treatment modalities and rehabilitation programs focusing on the aetiology of falling in the elderly individuals should be organized.

Keywords

• Knee replacement
• kinesiophobia
• fall risk
• osteoarthritis

References

1. 1. Matsumoto, H., Okuno, M., Nakamura, T., Yamamoto, K., Hagino, H. Fall incidence and risk factors in patients after total knee arthroplasty. Archives of orthopaedic and trauma surgery. 2012; 132(4):555-563
2. 2. Cai L, Liu Y, Xu H, Xu Q, Wang Y, Lyu P. Incidence and Risk Factors of Kinesiophobia After Total Knee Arthroplasty in Zhengzhou, China: A Cross-Sectional Study. J Arthroplasty. 2018;33(9):2858-2862. 3. Swinkels, A., Newman, J. H., &Allain, T. J. A prospective observational study of falling before and after knee replacement surgery. Age and Ageing. 2008; 38(2), 175-181.
3. 4. Piva SR, Gil AB, Almeida GJM, DiGioia AM, Levison TJ, Fitzgerald GK. (2010). A Balance Exercise Program Appears to Improve Function for Patients With Total Knee Arthroplasty: A Randomized Clinical Trial. Physical Therapy, 90(6): 880–894.
4. 5.Weber M, Völlner F, Benditz A, Schwarz T, Wörner M, Craiovan B, et al. Kniegelenkersatz des älteren Menschen [Total knee arthroplasty in the elderly]. Orthopade. 2017;46(1):34-39.
5. 6. Rajan RA, Pack Y, Jackson H, Gillies C, Asirvatham R. No need for outpatient physiotherapy following total knee arthroplasty: a randomized trial of 120patients. Acta Orthop Scand. 2004;75(1):71-3.
6. 7. Swinkels A, Newman JH, Allain TJ. Prospective observational study of falling before and after knee replacement surgery Age and Ageing.2009; 38: 175–181.
7. 8.Yilmaz Ö. T., Yakut, Y., Uygur, F., Uluğ, N. (2011). Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. FizyoterapiRehabilitasyon, 22(1), 44-9.
8. 9. Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018. US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / July 10, 2020 / Vol. 69 / No. 27

9. 10. Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, et al. Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheum. 2006; 55:610–615
10. 11. Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol Med Sci. 1989;44:M112-7
11. 12. Hill K. Activities-specific and Balance Confidence (ABC) Scale. Aust J Physiother. 2005;51: 197
12. 13. Matsumoto H, Okuno M, Nakamura T, Yamamoto K, Hagino H. Fall incidence and risk factors in patients after total knee arthroplasty. Arch Orthop Trauma Surg. 2012; 132:555–563.
13. 14. Rıddle DI, Golladay GJ. A longitudinal comparative study of falls in persons with knee arthroplasty and persons with or at high risk for knee osteoarthritis. Age and Ageing 2016; 45: 794–800.
14. 15. Mandl LA, Lyman S, Quinlan P, et al. Falls among patients who had elective orthopaedic surgery: a decade of experience from a musculoskeletal specialty hospital. J Orthop Sports Phys Ther 2013;43:91–6
15. 16. Johnson RL, Duncan CM, Ahn KS, Schroeder DR, Horlocker TT, Kopp SL. Fall-prevention strategies and patient characteristics that impact fall rates after total knee arthroplasty. Anesth Analg. 2014;119(5):1113-8.
16. 17. Levinger P, Wee E, Margelis S, Menz HB, Bartlett JR, Bergman NR, et al. Pre-operative predictors of post-operative falls in people undergoing total hip and knee replacement surgery: a prospective study. Arch Orthop Trauma Surg. 2017;137:1–9.
17. 18. Howland J, Lachman ME, Peterson EW, Cote J, Kasten L, Jette A. Covariates of fear of falling and associated activity curtailment. Gerontologist. 1998; 38: 549– 555.
18. 19. Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: The survey of activities and fear of falling in the elderly (SAFE). J Gerontol B Psychol Sci Soc Sci. 1998; 53B: P43– P50.
19. 20. Jørgensen CC, Kehlet H, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group. Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success? Clin Interv Aging. 2013;8:1569-77.
20. 21. Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P. Falling after total knee arthroplasty tors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res. 1998;13:1932-9.
21. 22. Swinkels A, Allain TJ. Physical performance tests, self-reported outcomes, and accidental falls before and after total knee arthroplasty: An exploratory study. Physiotherapy Theory and Practice. 2013;29(6):432–442.