Pre-operative Risk Factors for Postoperative Falls in Persons with Hip or Knee Arthroplasty: A Longitudinal Study of Data from the Osteoarthritis Initiative
Daniel L. Riddle, PhD and Gregory J. Golladay, MDHip Knee
Objective
The primary purpose was to identify preoperative risk factors associated with post-hospitalization falls over an approximate 2-year postoperative period in patients undergoing hip and knee arthroplasty.
Design
The study utilized a longitudinal cohort design.
Setting
Participants were recruited from communities surrounding four urban university-based medical centers.
Participants
All participants underwent hip or knee arthroplasty over a 9-year study period and were followed yearly in the Osteoarthritis Initiative study.
Main Outcome Measure
The primary outcome measure was a self-reported history of falls over the two-year postoperative period. A fall was recorded when the participant reported landing on the floor or ground. Preoperative predictors of falls derived from prior evidence included preoperative fall history, depressive symptom severity, narcotic use, age, activity level and comorbidity. Multinomial regression analysis was applied to determine factors that predicted either a single fall or multiple falls during a two-year postoperative period.
Results
Preoperative predictors of multiple postoperative falls were a preoperative history of falling, depressive symptoms and hip versus knee arthroplasty. Patients with hip arthroplasty were more than twice as likely (Odds Ratio = 2.26, 95% CI = 1.21, 4.20) as patients with knee arthroplasty to have multiple self-reported falls in the first two 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 with 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 following hip or knee arthroplasty.
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