Skip to main content

Advertisement

SpringerLink
Log in

Are people following hip and knee arthroplasty at greater risk of experiencing a fall and fracture? Data from the Osteoarthritis Initiative

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Falls are a major challenge for older people and are a significant source of mortality and morbidity. There has been uncertainty as to whether people with total hip (THA) or knee (TKA) arthroplasty have a greater risk of falls and associated fractures. This analysis was to explore this question with a large community dataset.

Materials and methods

Data from all people enroled onto the US Osteoarthritis Initiative programme who had undergone a THA (n = 104) or TKA (n = 165), within a 12-month period, were compared to those who had not undergone an arthroplasty (n = 4631). Data were collected on: the number of participants who reported a fall within a 12-month period; the frequency of falls in this period; and whether a fracture was sustained during this period. Odd ratios were calculated for the probability of experiencing a fall or fracture between the groups.

Results

There was no statistical difference in falls between people following THA (OR 0.90; 95 % CI 0.58–1.41) or TKA (OR 0.95; 0.67–1.35) compared to a non-arthroplasty cohort. Whilst there was no statistical difference in fracture risk between people following TKA compared to non-arthroplasty individuals (OR 1.25; 95 % CI 0.57–2.70), those who underwent THA had a 65 % lower chance of experiencing a fracture in the initial 12 post-operative months compared to the non-THA cohort (OR 0.35; 95 % CI 0.19–0.65; p < 0.01).

Conclusions

There appears a lower chance of experiencing a fracture for people following THA compared to those who have not.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Evans D, Pester J, Vera L, Jeanmonod D, Jeanmonod R (2015) Elderly fall patients triaged to the trauma bay: age, injury patterns, and mortality risk. Am J Emerg Med 33:1635–1638. doi:10.1016/j.ajem.2015.07.044

    Article  PubMed  Google Scholar 

  2. Health Quality Ontario (2008) Prevention of falls and fall-related injuries in community-dwelling seniors: an evidence-based analysis. Ont Health Technol Assess Ser 8:1–78

    Google Scholar 

  3. Do MT, Chang VC, Kuran N, Thompson W (2015) Fall-related injuries among Canadian seniors, 2005–2013: an analysis of the Canadian Community Health Survey. Health Promot Chronic Dis Prev Can 35:99–108

    CAS  PubMed  Google Scholar 

  4. National Clinical Guideline Centre (UK) (2014) Osteoarthritis: care and management in adults. National Institute for Health and Care Excellence (UK), London. https://www.nice.org.uk/Guidance/CG177. Accessed 18 Mar 2016

    Google Scholar 

  5. Culliford D, Maskell J, Judge A, Cooper C, Prieto-Alhambra D, Arden NK, COASt Study Group (2015) Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. Osteoarthritis Cartilage 23:594–600

    Article  CAS  PubMed  Google Scholar 

  6. Bade MJ, Kohrt WM, Stevens-Lapsley JE (2010) Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 40:559–567

    Article  PubMed  PubMed Central  Google Scholar 

  7. van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, Dekker J (2014) Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil 95:1962–1968

    Article  PubMed  Google Scholar 

  8. Vennu V, Bindawas SM (2014) Relationship between falls, knee osteoarthritis, and health-related quality of life: data from the Osteoarthritis Initiative study. Clin Interv Aging 9:793–800

    Article  PubMed  PubMed Central  Google Scholar 

  9. Doré AL, Golightly YM, Mercer VS, Shi XA, Renner JB, Jordan JM, Nelson AE (2015) Lower-extremity osteoarthritis and the risk of falls in a community-based longitudinal study of adults with and without osteoarthritis. Arthritis Care Res 67:633–639

    Article  Google Scholar 

  10. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146

    PubMed  Google Scholar 

  11. Matsumoto H, Okuno M, Nakamura T, Yamamoto K, Osaki M, Hagino H (2014) Incidence and risk factors for falling in patients after total knee arthroplasty compared to healthy elderly individuals. Yonago Acta Med 57:137–145

    PubMed  PubMed Central  Google Scholar 

  12. Soison A, Riratanapong S, Chouwajaroen N, Chantowart C, Buranapiyawong L, Kaewkot S, Kosuwon W (2014) Prevalence of fall in patients with total knee arthroplasty living in the community. J Med Assoc Thai 97:1338–1343

    PubMed  Google Scholar 

  13. Ikutomo H, Nagai K, Nakagawa N, Masuhara K (2015) Falls in patients after total hip arthroplasty in Japan. J Orthop Sci 20:663–668

    Article  PubMed  Google Scholar 

  14. Swinkels A, Allain TJ (2013) Physical performance tests, self-reported outcomes, and accidental falls before and after total knee arthroplasty: an exploratory study. Physiother Theory Pract 29:432–442

    Article  PubMed  Google Scholar 

  15. Swinkels A, Newman JH, Allain TJ (2009) A prospective observational study of falling before and after knee replacement surgery. Age Ageing 38:175–181

    Article  PubMed  Google Scholar 

  16. Lalmohamed A, Opdam F, Arden NK, Prieto-Alhambra D, van Staa T, Leufkens HG, de Vries F (2012) Knee arthroplasty and risk of hip fracture: a population-based, case-control study. Calcif Tissue Int 90:144–150

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Prieto-Alhambra D, Javaid MK, Maskell J, Judge A, Nevitt M, Cooper C, Arden NK (2011) Changes in hip fracture rate before and after total knee replacement due to osteoarthritis: a population-based cohort study. Ann Rheum Dis 70:134–138

    Article  PubMed  Google Scholar 

  18. Majewski M, Bischoff-Ferrari HA, Grüneberg C, Dick W, Allum JH (2005) Improvements in balance after total hip replacement. J Bone Joint Surg Br 87:1337–1343

    Article  CAS  PubMed  Google Scholar 

  19. Chang QZ, Sohmiya M, Wada N, Tazawa M, Sato N, Yanagisawa S, Shirakura K (2011) Alternation of trunk movement after arthroplasty in patients with osteoarthritis of the knee. J Orthop Sci 16:382–388

    Article  PubMed  Google Scholar 

  20. Miki H, Sugano N, Hagio K, Nishii T, Kawakami H, Kakimoto A, Nakamura N, Yoshikawa H (2004) Recovery of walking speed and symmetrical movement of the pelvis and lower extremity joints after unilateral THA. J Biomech 37:443–455

    Article  PubMed  Google Scholar 

  21. Washburn RA, Smith KW, Jette AM, Janney CA (1993) The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162

    Article  CAS  PubMed  Google Scholar 

  22. Levinger P, Menz HB, Wee E, Feller JA, Bartlett JR, Bergman NR (2011) Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery. Knee Surg Sports Traumatol Arthrosc 19:1082–1089

    Article  PubMed  Google Scholar 

  23. Prieto-Alhambra D, Javaid MK, Judge A, Maskel J, Kiran A, de Vries F, Cooper C, Arden NK (2011) Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use. Arthritis Rheum 63:992–1001

    Article  CAS  PubMed  Google Scholar 

  24. National Institute for Health and Care Excellence (UK) (2011) The management of hip fracture in adults. (UK), London. https://www.nice.org.uk/Guidance/CG124. Accessed 18 Mar 2016

  25. Lowdon DW, Quinn C, Mole P, Leese GP (2006) Osteoporosis assessment and treatment in older patients who have sustained a hip fracture. Scott Med J 51:32–35

    Article  PubMed  Google Scholar 

  26. Prieto-Alhambra D, Javaid MK, Judge A, Maskell J, Kiran A, Cooper C, Arden NK (2011) Bisphosphonate use and risk of post-operative fracture among patients undergoing a total knee replacement for knee osteoarthritis: a propensity score analysis. Osteoporos Int 22:1555–1571

    Article  CAS  PubMed  Google Scholar 

  27. de Zwart AH, van der Esch M, Pijnappels MA, Hoozemans MJ, van der Leeden M, Roorda LD, Dekker J, Lems WF, van Dieën JH (2015) Falls associated with muscle strength in patients with knee osteoarthritis and self-reported knee instability. J Rheumatol 42:1218–1223

    Article  PubMed  Google Scholar 

  28. Muraki S, Akune T, Oka H, Ishimoto Y, Nagata K, Yoshida M, Tokimura F, Nakamura K, Kawaguchi H, Yoshimura N (2013) Physical performance, bone and joint diseases, and incidence of falls in Japanese men and women: a longitudinal cohort study. Osteoporos Int 24:459–466

    Article  CAS  PubMed  Google Scholar 

  29. Shan L, Shan B, Graham D, Saxena A (2014) Total hip replacement: a systematic review and meta-analysis on mid-term quality of life. Osteoarthritis Cartilage 22:389–406

    Article  CAS  PubMed  Google Scholar 

  30. Khatib Y, Madan A, Naylor JM, Harris IA (2015) Do psychological factors predict poor outcome in patients undergoing TKA? A systematic review. Clin Orthop Relat Res 473:2630–2638

    Article  PubMed  Google Scholar 

  31. Lungu E, Desmeules F, Dionne CE, Belzile EL, Vendittoli PA (2014) Prediction of poor outcomes 6 months following total knee arthroplasty in patients awaiting surgery. BMC Musculoskelet Disord 15:299

    Article  PubMed  PubMed Central  Google Scholar 

  32. Browne JP, Bastaki H, Dawson J (2013) What is the optimal time point to assess patient-reported recovery after hip and knee replacement? A systematic review and analysis of routinely reported outcome data from the English patient-reported outcome measures programme. Health Qual Life Outcomes 11:128

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kennedy DM, Stratford PW, Robarts S, Gollish JD (2011) Using outcome measure results to facilitate clinical decisions the first year after total hip arthroplasty. J Orthop Sports Phys Ther 41:232–239

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding

The OAI is a public–private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.

Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich Research Park, Queen’s Building, Norwich, NR4 7TJ, UK

    T. O. Smith

  2. Hinchingbrooke Hospital, Cambridgeshire Community Services, Huntingdon, Cambridgeshire, UK

    M. Pearson

  3. St George’s Hospital, London, UK

    S. K. Latham

Authors
  1. T. O. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Pearson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. K. Latham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. O. Smith.

Ethics declarations

Conflict of interest

None.

Patient consent

Obtained.

Ethics approval

Committee on Human Research, University of California, San Francisco (IRB approval number 10-00532 Approved 10th March 2015).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 11 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, T.O., Pearson, M. & Latham, S.K. Are people following hip and knee arthroplasty at greater risk of experiencing a fall and fracture? Data from the Osteoarthritis Initiative. Arch Orthop Trauma Surg 136, 865–872 (2016). https://doi.org/10.1007/s00402-016-2445-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2445-5

Keywords

Search

Navigation