medwireNews: The authors of a systematic review and meta-analysis have identified several modifiable and nonmodifiable risk factors for falls following hip or knee replacement.
The analysis included 12 studies involving over 1.2 million participants in total. Rates of falls during the first year following surgery ranged from 25.0% to 36.0% for people undergoing total hip arthroplasty (THA), and from 6.2% to 42.6% among those undergoing total knee arthroplasty (TKA).
Arnold Wong (The Hong Kong Polytechnic University, China) and fellow researchers report 29 risk factors for postoperative falls, of which eight were based on moderate levels of evidence and the remainder on low or very low levels of evidence.
They found moderate evidence suggesting that surgery-related complications or comorbidities are associated with an increased risk for inpatient falls after THA/TKA; the presence of electrolyte or fluid abnormalities was associated with a 1.82-fold increased risk on meta-analysis, while coagulopathy was associated with a 1.53-fold increased risk.
Moderate evidence also indicated that patients undergoing revision THA/TKA were more likely to experience inpatient falls than those undergoing primary procedures, with odds ratios (ORs) of 1.92–2.13.
For post-discharge falls, the investigators found moderate evidence to suggest that medication use, psychiatric diseases, and living alone were all associated with an increased risk following THA/TKA. Prior history of TKA was identified as a risk factor for post-discharge falls in THA patients, while history of falls and female sex were both associated with post-discharge falls among TKA patients.
These findings “highlight the importance of developing strategies to lower the falls risk among patients following THA/TKA,” write Wong and colleagues in Osteoarthritis & Cartilage.
They recommend that “[c]linicians can alert patients with non-modifiable risk factors,” such as prior fall history or prior surgery, about their elevated risk for falls, “and comprehensively evaluate the presence of other modifiable risk factors so that appropriate multicomponent fall prevention interventions (e.g., patient education, home modification, medication review, safe assistive device, balance training exercise programs, and/or training in fall techniques) can be implemented to reduce the risk and impacts of falls.”
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