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Age and Ageing Advance Access originally published online on November 21, 2008
Age and Ageing 2009 38(2):175-181; doi:10.1093/ageing/afn229
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© The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

A prospective observational study of falling before and after knee replacement surgery

Annette Swinkels1, John H. Newman2 and Theresa J. Allain3

1 Faculty of Health and Life Sciences, University of the West of England, Blackberry Hill, Bristol BS16 1DD, UK
2 Avon Orthopaedic Centre, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
3 Department of Care of the Elderly, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK

Address correspondence to: A. Swinkels. Tel: (+44) 117 3288785; Fax: (+44) 117 3288437. Email: annette.swinkels{at}uwe.ac.uk

Background: knee arthritis is a risk factor for falling. Increasing numbers of people are receiving total knee arthroplasty (TKA) but the natural history of falling before and after TKA is unknown.

Objective: to prospectively monitor falls in pre- and post-operative TKA patients and to identify independent risk factors for post-operative falling.

Design: a prospective observational study with a 1-year follow-up.

Participants: community-dwelling older people recruited from a regional orthopaedic centre.

Methods: consecutive patients added to the TKA waiting list who completed monthly falls diaries, pre-operatively and 1 year post-operatively. Data on knee status (WOMAC: pain, stiffness and function), balance confidence (the Activities Balance Confidence Scale-UK—ABC-UK) and mood (Geriatric Depression Scale—GDS) were collected at quarterly intervals.

Results: ninety-nine patients received a primary TKA. 24.2% fell in the last pre-operative quarter (24 patients reported 44 falls) and this decreased to 11.7–11.8% in the first four post-operative quarters. 45.8% of people who fell pre-operatively fell again in the first post-operative year. Higher pre-operative GDS scores and a history of falling were significant independent predictors of post-operative falling.

Conclusion: a recent history of falling is common in people undergoing TKA and ~45% of patients fall again in the year following surgery. Patients being considered for TKA should be asked about falls history and undergo falls risk assessment and intervention.

Keywords: total knee arthroplasty, falls, WOMAC, depression, balance confidence, elderly

Received 18 February 2008; accepted in revised form 24 July 2008.


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