Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2011

01-07-2011 | Knee

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

Authors: Pazit Levinger, Hylton B. Menz, Elin Wee, Julian A. Feller, John R. Bartlett, Neil R. Bergman

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2011

Login to get access

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.
Literature
1.
Access Economics (2007) Painful realities: the economic impact of arthritis in Australia in 2007. Arthritis Australia, Sydney
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 89:893–900PubMedCrossRef
4.
Bellamy N (1989) Pain assessment in osteoarthritis: experience with the WOMAC osteoarthritis index. Semin Arthritis Rheum 18:14–17PubMedCrossRef
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 81:660–662PubMedCrossRef
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 17:365–372PubMedCrossRef
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
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 416:27–36PubMedCrossRef
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–M117PubMed
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 423:138–143PubMedCrossRef
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
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 68:642–647PubMedCrossRef
13.
14.
Fessel KD, Nevitt MC (1997) Correlates of fear of falling and activity limitation among persons with rheumatoid arthritis. Arthritis Care Res 10:222–228PubMedCrossRef
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 19:47–55PubMedCrossRef
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 14:533–539PubMedCrossRef
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 16:200–209PubMedCrossRef
18.
Fuchs S, Thorwesten L, Niewerth S (1999) Proprioceptive function in knees with and without total knee arthroplasty. Am J Phys Med Rehabil 78:39–45PubMedCrossRef
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 60:612–618PubMedCrossRef
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 61:422–428PubMedCrossRef
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 80:163–173PubMed
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 8:209–224PubMedCrossRef
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 5:229–243PubMedCrossRef
24.
Hurley MV, Scott DL, Rees J, Newham DJ (1997) Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis 56:641–648PubMedCrossRef
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 14:212–217PubMedCrossRef
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 49:884–891PubMedCrossRef
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 37:45–50PubMedCrossRef
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 59:331–337PubMedCrossRef
29.
Lawlor DA, Patel R, Ebrahim S (2003) Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 327:712–717PubMedCrossRef
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 47:30–39PubMed
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 50:671–678PubMedCrossRef
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 302:2214–2221PubMedCrossRef
33.
Lord SR, Clark RD, Webster IW (1991) Physiological factors associated with falls in an elderly population. J Am Geriatr Soc 39:1194–1200PubMed
34.
Lord SR, McLean D, Stathers G (1992) Physiological factors associated with injurious falls in older people living in the community. Gerontology 38:338–346PubMedCrossRef
35.
Lord SR, Menz HB, Tiedemann A (2003) A physiological profile approach to falls risk assessment and prevention. Phys Ther 83:237–252PubMed
36.
Lord SR, Ward JA, Williams P, Anstey KJ (1994) Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 42:1110–1117PubMed
37.
March LM, Bagga H (2004) Epidemiology of osteoarthritis in Australia. Med J Aust 180:S6–S10PubMed
38.
Martin JA, Buckwalter JA (2002) Aging, articular cartilage chondrocyte senescence and osteoarthritis. Biogerontology 3:257–264PubMedCrossRef
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–M666PubMed
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 38:246–256PubMed
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 35:424–436PubMed
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 52:1121–1129PubMedCrossRef
43.
Murray DW, Frost SJ (1998) Pain in the assessment of total knee replacement. J Bone Joint Surg Br 80:426–431PubMedCrossRef
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 47:1371–1378PubMed
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 127:97–104PubMed
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 7:328–334CrossRef
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 31:2272–2279PubMed
48.
Swinkels A, Newman JH, Allain TJ (2009) A prospective observational study of falling before and after knee replacement surgery. Age Ageing 38:175–181PubMedCrossRef
49.
Symmons DP (2001) Knee pain in older adults: the latest musculoskeletal “epidemic”. Ann Rheum Dis 60:89–90PubMedCrossRef
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 273:1348–1353PubMedCrossRef
51.
Valtonen A, Poyhonen T, Heinonen A, Sipila S (2009) Muscle deficits persist after unilateral knee replacement and have implications for rehabilitation. Phys Ther 89:1072–1079PubMedCrossRef
52.
Verzijl N, Bank RA, TeKoppele JM, DeGroot J (2003) AGEing and osteoarthritis: a different perspective. Curr Opin Rheumatol 15:616–622PubMedCrossRef
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 78:248–258PubMed
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 91:106–114PubMedCrossRef
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
Metadata
Title
Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery
Authors
Pazit Levinger
Hylton B. Menz
Elin Wee
Julian A. Feller
John R. Bartlett
Neil R. Bergman
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-010-1325-8

Other articles of this Issue 7/2011

Knee Surgery, Sports Traumatology, Arthroscopy 7/2011 Go to the issue

Editorial

Total knee arthroplasty—what do we know and what don’t

Experimental Study

Lidocaine cytotoxicity to the bovine articular chondrocytes in vitro: changes in cell viability and proteoglycan metabolism

Knee

Mid-term outcomes of computer-assisted total knee arthroplasty

Knee

Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiency

Knee

Is postural control restored following anterior cruciate ligament reconstruction? A systematic review

Experimental Study

Outcomes of untreated posterolateral knee injuries: an in vivo canine model