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Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Knee osteoarthritis (OA) is a major cause of disability and a risk factor for falls in older people. The purpose of this study was to assess the falls risk of people with knee OA before surgery and at 4 months following surgery and to compare this to a control group.

Methods

Thirty-five patients with knee OA prior to undergoing knee replacement surgery and 27 asymptomatic age-matched controls participated in the study. The surgical group were tested prior to their surgery and at 4 months post-surgery. The short form of the Physiological Profile Assessment was used to assess falls risk and included tests of vision, lower limb proprioception, knee extension strength, reaction time and postural sway. Physical activity, quality of life, fear of falls and disability before and after surgery were also documented.

Results

At least one fall in the previous 12 months was reported for 48% of the surgical group compared with 30% of the control group. Following the surgery, there was a reduction in fear of falling and pain, and improvements in function for the surgical group. However, compared to the control group, the surgical group exhibited a greater fear of falling and reduced lower limb proprioception and knee extension strength both pre- and post-surgery.

Conclusion

People who undergo knee replacement surgery may be at increased risk of falls both prior to and 4 months following their surgery, primarily due to deficits in knee extension strength and lower limb proprioception. Therefore, interventions to reduce the risk of falls should be implemented early after the surgery.

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References

  1. Access Economics (2007) Painful realities: the economic impact of arthritis in Australia in 2007. Arthritis Australia, Sydney

    Google Scholar 

  2. Australian Orthopeadic Association (2009). Hip and knee arthroplasty. National joint replacement surgery, Annual report

  3. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the national joint registry for England and Wales. J Bone Joint Surg Br 89:893–900

    Article  PubMed  CAS  Google Scholar 

  4. Bellamy N (1989) Pain assessment in osteoarthritis: experience with the WOMAC osteoarthritis index. Semin Arthritis Rheum 18:14–17

    Article  PubMed  CAS  Google Scholar 

  5. Birdsall PD, Hayes JH, Cleary R, Pinder IM, Moran CG, Sher JL (1999) Health outcome after total knee replacement in the very elderly. J Bone Joint Surg Br 81:660–662

    Article  PubMed  CAS  Google Scholar 

  6. Blake AJ, Morgan K, Bendall MJ, Dallosso H, Ebrahim SB, Arie TH, Fentem PH, Bassey EJ (1988) Falls by elderly people at home: prevalence and associated factors. Age Ageing 17:365–372

    Article  PubMed  CAS  Google Scholar 

  7. Brand C, Juan AW, Lowe A, Morton C (2005) Prevalence, outcome and risk for falling in 155 ambulatory patients with rheumatic disease. J Rheumatol 8:99–105

    Google Scholar 

  8. Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T (2003) Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 416:27–36

    Article  PubMed  Google Scholar 

  9. Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community based prospective study of people 70 years and older. J Gerontol 44:M112–M117

    PubMed  CAS  Google Scholar 

  10. Collier MB, McAuley JP, Szuszczewicz ES, Engh GA (2004) Proprioceptive deficits are comparable before unicondylar and total knee arthroplasties, but greater in the more symptomatic knee of the patient. Clin Orthop Relat Res 423:138–143

    Article  PubMed  Google Scholar 

  11. Cripps R, Carman J (2001) Falls by the elderly in Australia: trends and data for 1998. Australian Institute of Health and Welfare, Canberra, pp 1–31

    Google Scholar 

  12. Cushnaghan J, Bennett J, Reading I, Croft P, Byng P, Cox K, Dieppe P, Coggon D, Cooper C (2009) Long-term outcome following total knee arthroplasty: a controlled longitudinal study. Ann Rheum Dis 68:642–647

    Article  PubMed  CAS  Google Scholar 

  13. Delbaere K, Hauer K, Lord SR (2010) Evaluation Of The Incidental And Planned Activity Questionnaire (IPAQ) For Older People. Br J Sports Med. doi:10.1136/bjsm.2009.060350

    PubMed  Google Scholar 

  14. Fessel KD, Nevitt MC (1997) Correlates of fear of falling and activity limitation among persons with rheumatoid arthritis. Arthritis Care Res 10:222–228

    Article  PubMed  CAS  Google Scholar 

  15. Fisher NM, White SC, Yack HJ, Smolinski RJ, Pendergast DR (1997) Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation. Disabil Rehabil 19:47–55

    Article  PubMed  CAS  Google Scholar 

  16. Foley SJ, Lord SR, Srikanth V, Cooley H, Jones G (2006) Falls risk is associated with pain and dysfunction but not radiographic osteoarthritis in older adults: tasmanian older adult cohort study. Osteoarthr Cartil 14:533–539

    Article  PubMed  CAS  Google Scholar 

  17. Frost H, Lamb SE, Robertson S (2002) A randomized controlled trial of exercise to improve mobility and function after elective knee arthroplasty. Feasibility, results and methodological difficulties. Clin Rehabil 16:200–209

    Article  PubMed  CAS  Google Scholar 

  18. Fuchs S, Thorwesten L, Niewerth S (1999) Proprioceptive function in knees with and without total knee arthroplasty. Am J Phys Med Rehabil 78:39–45

    Article  PubMed  CAS  Google Scholar 

  19. Hassan BS, Mockett S, Doherty M (2001) Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis 60:612–618

    Article  PubMed  CAS  Google Scholar 

  20. Hassan BS, Doherty SA, Mockett S, Doherty M (2002) Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis. Ann Rheum Dis 61:422–428

    Article  PubMed  CAS  Google Scholar 

  21. Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D (1998) Health-related quality of life after knee replacement. J Bone Joint Surg Am 80:163–173

    PubMed  CAS  Google Scholar 

  22. Hawthorne G, Richardson J, Osborne R (1999) The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res 8:209–224

    Article  PubMed  CAS  Google Scholar 

  23. Howland J, Peterson EW, Levin WC, Fried L, Pordon D, Bak S (1993) Fear of falling among the community-dwelling elderly. J Aging Health 5:229–243

    Article  PubMed  CAS  Google Scholar 

  24. Hurley MV, Scott DL, Rees J, Newham DJ (1997) Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis 56:641–648

    Article  PubMed  CAS  Google Scholar 

  25. Isaac SM, Barker KL, Danial IN, Beard DJ, Dodd CA, Murray DW (2007) Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty. Knee 14:212–217

    Article  PubMed  CAS  Google Scholar 

  26. Jadelis K, Miller ME, Ettinger WH Jr, Messier SP (2001) Strength, balance, and the modifying effects of obesity and knee pain: results from the observational arthritis study in seniors (oasis). J Am Geriatr Soc 49:884–891

    Article  PubMed  CAS  Google Scholar 

  27. Kempen GI, Yardley L, van Haastregt JC, Zijlstra GA, Beyer N, Hauer K, Todd C (2008) The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing 37:45–50

    Article  PubMed  Google Scholar 

  28. Lamb SE, Guralnik JM, Buchner DM, Ferrucci LM, Hochberg MC, Simonsick EM, Fried LP (2000) Factors that modify the association between knee pain and mobility limitation in older women: the women’s health and aging study. Ann Rheum Dis 59:331–337

    Article  PubMed  CAS  Google Scholar 

  29. Lawlor DA, Patel R, Ebrahim S (2003) Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 327:712–717

    Article  PubMed  Google Scholar 

  30. Leipzig RM, Cumming RG, Tinetti ME (1999) Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 47:30–39

    PubMed  CAS  Google Scholar 

  31. Leveille SG, Bean J, Bandeen-Roche K, Jones R, Hochberg M, Guralnik JM (2002) Musculoskeletal pain and risk for falls in older disabled women living in the community. J Am Geriatr Soc 50:671–678

    Article  PubMed  Google Scholar 

  32. Leveille SG, Jones RN, Kiely DK, Hausdorff JM, Shmerling RH, Guralnik JM, Kiel DP, Lipsitz LA, Bean JF (2009) Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA 302:2214–2221

    Article  PubMed  CAS  Google Scholar 

  33. Lord SR, Clark RD, Webster IW (1991) Physiological factors associated with falls in an elderly population. J Am Geriatr Soc 39:1194–1200

    PubMed  CAS  Google Scholar 

  34. Lord SR, McLean D, Stathers G (1992) Physiological factors associated with injurious falls in older people living in the community. Gerontology 38:338–346

    Article  PubMed  CAS  Google Scholar 

  35. Lord SR, Menz HB, Tiedemann A (2003) A physiological profile approach to falls risk assessment and prevention. Phys Ther 83:237–252

    PubMed  Google Scholar 

  36. Lord SR, Ward JA, Williams P, Anstey KJ (1994) Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 42:1110–1117

    PubMed  CAS  Google Scholar 

  37. March LM, Bagga H (2004) Epidemiology of osteoarthritis in Australia. Med J Aust 180:S6–S10

    PubMed  Google Scholar 

  38. Martin JA, Buckwalter JA (2002) Aging, articular cartilage chondrocyte senescence and osteoarthritis. Biogerontology 3:257–264

    Article  PubMed  CAS  Google Scholar 

  39. McChesney JW, Woollacott MH (2000) The effect of age-related declines in proprioception and total knee replacement on postural control. J Gerontol A Biol Sci Med Sci 55:M658–M666

    PubMed  CAS  Google Scholar 

  40. Meier W, Mizner RL, Marcus RL, Dibble LE, Peters C, Lastayo PC (2008) Total knee arthroplasty: muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther 38:246–256

    PubMed  Google Scholar 

  41. Mizner RL, Petterson SC, Snyder-Mackler L (2005) Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 35:424–436

    PubMed  Google Scholar 

  42. Moreland JD, Richardson JA, Goldsmith CH, Clase CM (2004) Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 52:1121–1129

    Article  PubMed  Google Scholar 

  43. Murray DW, Frost SJ (1998) Pain in the assessment of total knee replacement. J Bone Joint Surg Br 80:426–431

    Article  PubMed  CAS  Google Scholar 

  44. Schwartz AV, Villa ML, Prill M, Kelsey JA, Galinus JA, Delay RR, Nevitt MC, Bloch DA, Marcus R, Kelsey JL (1999) Falls in older Mexican-American women. J Am Geriatr Soc 47:1371–1378

    PubMed  CAS  Google Scholar 

  45. Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, Wolinsky FD (1997) Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 127:97–104

    PubMed  CAS  Google Scholar 

  46. Stalenhoef PA, Crebolder HF, Knottnerus JA, Van der Horst F (1997) Incidence, risk factors and consequences of falls among elderly subjects living in the community: a criteria based analysis. Eur J Pub Health 7:328–334

    Article  Google Scholar 

  47. Sturnieks DL, Tiedemann A, Chapman K, Munro B, Murray SM, Lord SR (2004) Physiological risk factors for falls in older people with lower limb arthritis. J Rheumatol 31:2272–2279

    PubMed  Google Scholar 

  48. Swinkels A, Newman JH, Allain TJ (2009) A prospective observational study of falling before and after knee replacement surgery. Age Ageing 38:175–181

    Article  PubMed  Google Scholar 

  49. Symmons DP (2001) Knee pain in older adults: the latest musculoskeletal “epidemic”. Ann Rheum Dis 60:89–90

    Article  PubMed  CAS  Google Scholar 

  50. Tinetti ME, Inouye SK, Gill TM, Doucette JT (1995) Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 273:1348–1353

    Article  PubMed  CAS  Google Scholar 

  51. Valtonen A, Poyhonen T, Heinonen A, Sipila S (2009) Muscle deficits persist after unilateral knee replacement and have implications for rehabilitation. Phys Ther 89:1072–1079

    Article  PubMed  Google Scholar 

  52. Verzijl N, Bank RA, TeKoppele JM, DeGroot J (2003) AGEing and osteoarthritis: a different perspective. Curr Opin Rheumatol 15:616–622

    Article  PubMed  Google Scholar 

  53. Walsh M, Woodhouse LJ, Thomas SG, Finch E (1998) Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects. Phys Ther 78:248–258

    PubMed  CAS  Google Scholar 

  54. Williams SB, Brand CA, Hill KD, Hunt SB, Moran H (2010) Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study. Arch Phys Med Rehabil 91:106–114

    Article  PubMed  Google Scholar 

  55. Wolfson L, Judge J, Whipple R, King M (1995). Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci 50 Spec no: 64–67

    Google Scholar 

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Acknowledgments

This study was funded by the Clive and Vera Ramaciotti Foundation and the Arthritis Foundation of Australia. HBM is currently a National Health and Medical Research Council fellow (Clinical Career Development Award, ID: 433049). The authors would like to thank Margaret Perrott for her assistance in the data collection.

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Authors and Affiliations

  1. Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, 3086, Australia

    Pazit Levinger, Hylton B. Menz, Elin Wee & Julian A. Feller

  2. Warringal Private Medical Centre, Heidelberg, 3084, Australia

    John R. Bartlett & Neil R. Bergman

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  1. Pazit Levinger
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  2. Hylton B. Menz
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Correspondence to Pazit Levinger.

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Levinger, P., Menz, H.B., Wee, E. et al. Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery. Knee Surg Sports Traumatol Arthrosc 19, 1082–1089 (2011). https://doi.org/10.1007/s00167-010-1325-8

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  • DOI: https://doi.org/10.1007/s00167-010-1325-8

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