Falls in patients after total hip arthroplasty in Japan

doi:10.1007/s00776-015-0715-7

Journal of Orthopaedic Science

Volume 20, Issue 4, 2015, Pages 663-668

https://doi.org/10.1007/s00776-015-0715-7 Get rights and content

Abstract

Background

There have been few reports on falls in patients who have undergone total hip arthroplasty (THA). In the present study, we aimed to investigate the incidence and circumstances of falls in post-THA patients and to identify the factors associated with falling.

Materials and methods

After excluding comorbidities, osteoarthritis without THA, and patients who had undergone THA within the previous 1 year, 214 patients [11 males, 203 females; mean (SD) age, 66.0 (8.7) years] living independently for at least 1 year after THA were analyzed as available data. Using a self-administered questionnaire, we investigated the number and circumstances of falls in the preceding year, as well as functional outcome and ambulatory ability via the Oxford Hip Score. Multivariate logistic regression analysis was used to identify factors influencing falls in post-THA patients.

Results

The incidence of at least one fall in the past year was 36 %. Falls were most often caused by tripping and falling forward during the daytime. In the present study, 37.7 % of falls resulted in injuries and 5.2 % resulted in fractures. Experience of fall was significantly related to medication [odds ratio (OR) 4.09, 95 % confidence interval (CI) 1.90–8.80, P < 0.001] and postoperative duration (OR 0.89, 95 % CI 0.81–0.98, P < 0.05).

Conclusions

Thus, patients have an increased risk for falls and fall-induced injuries after THA. Falls in post-THA patients are associated with medication and shorter postoperative duration. Therefore, it is essential to prevent falls in patients who have undergone THA, particularly during the early postoperative period and among patients administered medications.

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Strong relationship of muscle force and fall efficacy, but not of gait kinematics, with number of falls in the year after Total Hip Arthroplasty for osteoarthritis: An exploratory study
2022, Clinical Biomechanics
In people with moderate hip osteoarthritis, gait kinematics was reported to be correlated with number of falls in the preceding year. After Total Hip Arthroplasty, subjects generally improve but still fall. The present study explores recovery and correlations with number of falls in the year after Total Hip Arthroplasty.
We assessed 12 patients one year after Total Hip Arthroplasty, 12 patients with moderate hip osteoarthritis with at least one fall in the preceding year, and 12 healthy peers. Maximum hip abduction strength, Fall Efficacy Scale - International, Harris Hip Score, pain, and number of falls in the preceding year were assessed. Participants walked on a treadmill with increasing speeds, and gait kinematics were registered optoelectronically. We assessed group differences, and correlations of all variables with number of falls.
After arthroplasty, subjects tended to score better on variables measured, often non-significantly, compared to subjects with moderate osteoarthritis, but worse than healthy peers. Maximum hip abduction strength together with fall efficacy had a strong regression on the number of falls in the preceding year (R² = 92%). Gait kinematics did not correlate with number of falls, and also fall efficacy was not related to gait kinematics.
One year after hip arthroplasty, muscle strength sufficiently recovered for normal walking, but not to avoid falling in risky situations. Rehabilitation should focus on muscle strength. The lack of correlation between the Fall Efficacy International and gait kinematics, suggests that it reflected the experience of having fallen rather than fear.
Machine Learning Predicts the Fall Risk of Total Hip Arthroplasty Patients Based on Wearable Sensor Instrumented Performance Tests
2021, Journal of Arthroplasty
The prevalence of falls affects the wellbeing of aging adults and places an economic burden on the healthcare system. Integration of wearable sensors into existing fall risk assessment tools enables objective data collection that describes the functional ability of patients. In this study, supervised machine learning was applied to sensor-derived metrics to predict the fall risk of patients following total hip arthroplasty.
At preoperative, 2-week, and 6-week postoperative appointments, patients (n = 72) were instrumented with sensors while they performed the timed-up-and-go walking test. Preoperative and 2-week postoperative data were used to form the feature sets and 6-week total times were used as labels. Support vector machine and linear discriminant analysis classifier models were developed and tested on various combinations of feature sets and feature reduction schemes. Using a 10-fold leave-some-subjects-out testing scheme, the accuracy, sensitivity, specificity, and area under the receiver-operator curve (AUC) were evaluated for all models.
A high performance model (accuracy = 0.87, sensitivity = 0.97, specificity = 0.46, AUC = 0.82) was obtained with a support vector machine classifier using sensor-derived metrics from only the preoperative appointment. An overall improved performance (accuracy = 0.90, sensitivity = 0.93, specificity = 0.59, AUC = 0.88) was achieved with a linear discriminant analysis classifier when 2-week postoperative data were added to the preoperative data.
The high accuracy of the fall risk prediction models is valuable for patients, clinicians, and the healthcare system. High-risk patients can implement preventative measures and low-risk patients can be directed to enhanced recovery care programs.
High prevalence of outpatient falls following elective shoulder arthroplasty
2020, Journal of Shoulder and Elbow Surgery
This study characterized the prevalence and risk factors of inpatient and outpatient postoperative falls in patients undergoing elective shoulder arthroplasty.
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.
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).
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.
Risk factors for falls in patients with total hip arthroplasty and total knee arthroplasty: a systematic review and meta-analysis
2019, Osteoarthritis and Cartilage
Citation Excerpt :
However, approximately 52% of post-THA/TKA patients fell within the first month after discharge31. The fall rates in the first 12 months after TKA ranged from 6.2% to 42.6%10,17,19,30,32, while those following THA ranged from 25%17 to 36 %18. The reported fall rate between 6 and 18 months post-TKA was 32.9%11, and the fall rate between 12 and 24 months post-TKA was 3.14%, which might reflect longer term recovery and the effects of postoperative rehabilitation32.
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.
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.
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.
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.
Quality of life, effects on Asian Lifestyle, and perceived satisfaction after total hip arthroplasty in Japan and Korea
2018, International Journal of Orthopaedic and Trauma Nursing
Citation Excerpt :
As 90% of the Japanese patients who underwent THA in the present study had osteoarthritis, this may have increased the Japanese anxiety scores; osteoarthritis has a very long disease duration and associated muscle weakness, so osteoarthritic patients commonly experience anxiety about their new life with the artificial joint (Loureiro et al., 2013; Webster et al., 2015). Furthermore, Ikumoto et al. (2015) reported that the incidence of falling in the first year after THA was 36% higher than that in the general older adult population, and that a falling experience may influence the degree of anxiety about dislocation. In the present study, the proportion of Korean patients who underwent THA due to fracture was much higher and their satisfaction was lower than that of Japanese patients.
The Asian lifestyle requires deep hip ﬂexion, which increases the risk of dislocation. Hence, Asian total hip arthroplasty (THA) patients may have problems postoperatively. This study aimed to 1) document quality of life (QoL), Asian lifestyle-related items (five postures that require deep hip flexion), and perceived satisfaction in patients who underwent THA in Japan versus Korea, 2) assess the differences in QoL and Asian lifestyle-related items by patient lifestyle, and 3) identify the factors predicting QoL.
This cross-sectional study included 222 THA patients. Korean patients completed the questionnaires. Japanese patients were then matched with Korean patients by age, sex, and post-THA period. Assessed parameters included QoL measured by the EuroQoL, Oxford hip score (OHS), Asian lifestyle (measured by the Asian lifestyle-related items), and perceived satisfaction (measured by the five items of postoperative satisfaction). Multiple regression analysis was used to determine the predictors of QoL.
Compared with Korean patients, Japanese patients had better QoL, but more difficulty performing postures requiring deep hip flexion. Greater QoL was associated with greater satisfaction. The predictors of decreased QoL after THA were lower OHS in both countries, worse squatting ability in Japan, and worse leg-crossing ability in Korea.
In Japan and Korea, the OHS is an important predictor of QoL after THA.
Gait Abnormality Predicts Falls in Women After Total Hip Arthroplasty
2018, Journal of Arthroplasty
Citation Excerpt :
Earlier studies reported that gait variability (eg, variability in stride time and foot clearance) was associated with trip-related falls in older adults [25,26]. Similarly, tripping is the most common cause of falls in patients after THA [2,15]. Therefore, women with gait abnormality after THA may also have increased gait variability and thus an increased risk of trip-related falls.
Patients who undergo total hip arthroplasty (THA) have an increased risk of falls during the first year postoperatively. However, risk factors for falls after THA remain unclear. We investigated the relationship between gait abnormality and falls during the first year after THA.
We conducted a prospective cohort study of 286 patients with severe hip osteoarthritis who underwent THA and examined fall history during the first year postoperatively. Baseline characteristics including age, body mass index, number of prescribed medications, comorbidities, and history of falling in the past year were evaluated as covariates and determined using a self-administered questionnaire and interview preoperatively. We assessed functional outcomes, including passive range of motion of the hip joint (flexion, extension, abduction, and adduction), muscle strength (hip abduction and knee extension), gait velocity, and gait abnormality, at 3 weeks postoperatively. Cox proportional hazard regression models were used to analyze the relationship between the presence of gait abnormality and falls.
One hundred sixty-two women were included. The incidence of at least 1 fall during the first year after THA was 31.5%. Cox proportional hazard regression models showed that the presence of gait abnormality (hazard ratio, 2.91; 95% confidence interval, 1.55-5.48; P < .001) was significantly associated with falls during the first year postoperatively.
The presence of gait abnormality is a useful screening tool to predict future falls in women after THA. Clinicians should assess gait abnormality to identify patients who may require fall prevention measures and continuous rehabilitation to improve gait abnormality.

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ORIGINAL ARTICLEFalls in patients after total hip arthroplasty in Japan

Abstract

Background

Materials and methods

Results

Conclusions

Arch Gerontol Geriatr

J Am Med Dir Assoc

Aust NZ J Public Health

J Orthop Sci

Clin Geriatric Med

Gait Posture

Fall-induced injuries and deaths among older adults

JAMA

Risk factors for falls among elderly persons living in the community

N Engl J Med

Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study

Age Ageing

Falls among community-dwelling elderly in Japan

J Bone Miner Res

Which neuromuscular or cognitive test is the optimal screening tool to predict falls in frail community-dwelling older people?

Gerontology

Physiological risk factors for falls in older people with lower limb arthritis

J Rheumatol

Chronic musculoskeletal pain and the occurrence of falls in an older population

JAMA

ORIGINAL ARTICLE
Falls in patients after total hip arthroplasty in Japan