Incidence and associated risk factors for falls in older adults following elective total knee replacement surgery - a prospective cohort study

OBJECTIVE: The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 months after elective, primary total knee replacement (TKR) surgery.

DESIGN: A prospective observational cohort of older adults undergoing TKR were followed. Baseline measurements included risk factors of history of falls, using a gait aid and number of medications. Falls data were recorded after discharge for 12 months alongside patient reported outcomes (Oxford knee score). Analyses used logistic and negative binomial regression modelling.

RESULTS: There were 267 participants [mean age 70 (6.7) years) enrolled. Participants who fell [n = 102 (40.6%)] reported 200 falls in the 12 months after surgery. The incidence of falls was 2.4 falls per 1000 patient days in the 12 months after surgery, with the highest incidence (2.6 falls per 1000 patient days) in month one. Risk factors for falling were a history of falls [AOR 2.41, 95% CI (1.35-4.31)] and number of central nervous system acting medications taken prior to surgery [AOR 1.66, 95% CI (1.25-2.21)]. Using a walking aid at baseline was associated with falls after discharge [AIRR 2.38, 95% CI (1.57-3.60)].

CONCLUSION: Older adults experience a high incidence of falls after elective TKR. Further research that investigates fall prevention after TKR is required.