Clinical Orthopaedics and Related Research®

, Volume 470, Issue 1, pp 244–249 | Cite as

Preoperative Patient Education Reduces In-hospital Falls After Total Knee Arthroplasty

  • Henry D. ClarkeEmail author
  • Vickie L. Timm
  • Brynn R. Goldberg
  • Steven J. Hattrup
Symposium: Papers Presented at the Annual Meetings of The Knee Society



Inpatient hospital falls after orthopaedic surgery represent a major problem, with rates of about one to three falls per 1000 patient days. These falls result in substantial morbidity for the patient and liability for the institution.


We determined whether preoperative patient education reduced the rate of in-hospital falls after primary TKA and documented the circumstances and the injuries resulting from the falls.

Patients and Methods

We reviewed data from all 244 patients who underwent primary TKA at a single institution between March and November 2009. Seventy-two patients of one surgeon were enrolled in a preoperative nurse-led education program. This group was compared with a control group of 172 patients who concurrently underwent TKA at the same institution but did not receive preoperative education.


More control patients had in-hospital falls than those in the education group: seven (one of whom had two falls) of 172 (4%) versus none of 72 (0%), respectively. Three of the eight falls resulted in a serious injury, including one wound dehiscence and one wound hematoma that both required repeat surgery and one clavicle fracture.


Inpatient falls after TKA may be associated with major complications. Our preoperative patient education reduced these falls and is now mandatory for patients undergoing TKA at our institution.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Education Group Fall Risk Minor Injury Clavicle Fracture Fall Rate 
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We thank Drs. Richard J. Claridge, Mark J. Spangehl, Christopher P. Beauchamp, and Adam J. Schwartz who contributed patients to the control group. We would also thank Catherine Cox, RN, and Brynn Corbett, RN, who provided data from our institutional databases pertaining to patient falls, and Linda Bucaro, Data Coordinator for the Department of Orthopedics, Mayo Clinic in Arizona, who crosschecked data between databases. We also acknowledge the statistical help we received from the statisticians in the Center for Translational Science Activities at the Mayo Clinic. Finally, we thank Brie N. Noble from the Department of Biostatistics, Mayo Clinic in Arizona, for additional statistical support.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Henry D. Clarke
    • 1
    Email author
  • Vickie L. Timm
    • 1
  • Brynn R. Goldberg
    • 1
  • Steven J. Hattrup
    • 1
  1. 1.Department of Orthopedic SurgeryMayo ClinicPhoenixUSA

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