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Preoperative Risk Factors for Postoperative Falls in Persons Undergoing Hip or Knee Arthroplasty: A Longitudinal Study of Data From the Osteoarthritis Initiative

Published:February 03, 2018DOI:https://doi.org/10.1016/j.apmr.2017.12.030

      Abstract

      Objective

      To identify preoperative risk factors associated with posthospitalization falls over an approximate 2-year postoperative period in patients undergoing both hip and knee arthroplasty.

      Design

      A longitudinal cohort design.

      Setting

      Communities surrounding 4 urban university–based medical centers.

      Participants

      Adults (N = 596) with hip or knee arthroplasty over a 9-year period and followed yearly.

      Interventions

      Not applicable.

      Main Outcome Measures

      The primary outcome measure was a self-reported history of falls over the 2-year postoperative period. A fall was recorded when the participant reported landing on the floor or ground. Preoperative predictors of falls derived from previous evidence included preoperative fall history, depressive symptom severity, narcotic use, age, activity level, and comorbidity. Multinomial regression analysis was performed to determine factors that predicted either a single fall or multiple falls during a 2-year postoperative period.

      Results

      Preoperative predictors of multiple postoperative falls were a preoperative history of falls, depressive symptoms, and hip vs knee arthroplasty. Patients with hip arthroplasty were more than twice as likely (odds ratio, 2.26; 95% confidence interval, 1.21–4.20) as patients with knee arthroplasty to have multiple self-reported falls in the first 2 postoperative years. No predictors were found for persons who reported falling only once postoperatively. Findings were generally supported in a sensitivity analysis.

      Conclusions

      Clinicians involved in the pre- and postoperative care of persons undergoing hip or knee arthroplasty can use these findings to inform fall risk screening and intervention delivery to reduce fall risk in patients who are at risk for multiple falls after hip or knee arthroplasty.

      Keywords

      List of abbreviations:

      CI (confidence interval), HA (hip arthroplasty), KA (knee arthroplasty), OA (osteoarthritis), OAI (Osteoarthritis Initiative), OR (odds ratio)
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