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Falling risk in patients with end-stage knee osteoarthritis

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Abstract

Although 25% of patients with end-stage knee osteoarthritis (OA) have reported a fall, there is limited information about risk factors for falling in patients awaiting total knee arthroplasty (TKA). The purpose of this study was to identify clinical and functional measures related to fall risk. A total of 259 participants awaiting TKA for OA participated in this secondary cross-sectional study. Participants were divided into fallers and non-fallers based on falling history in the prior 6 months. Clinical measures (hip and knee pain, neck and low back pain (LBP), knee range of motion, and quadriceps strength) and functional measures (six-minute walk test (6MWT), timed up and go test, and Knee Injury and Osteoarthritis Outcome Score (KOOS)) were assessed in patients 2–4 weeks prior to TKA. Independent t tests were used to examine differences between groups. Odds ratio was calculated to identify clinical risk factors for falling. Of all participants, 47 (18%) reported a fall in the previous 6 months. Fallers had 30% greater LBP (3.0 ± 2.5 vs. 2.1 ± 2.6; p = 0.025). Fallers walked 12% shorter distance in the 6MWT than non-fallers (378 ± 100 vs. 422 ± 105 m; p = 0.010). For every 1-point increase in LBP on a 0–10 scale, there was a 14% greater risk of falling (p = 0.028). For every 10-m increase in 6MWT, there was a 3.8% reduction in fall risk (p = 0.011). Greater LBP and worse walking endurance are associated with falls in individuals with end-stage OA. Future studies should determine if interventions that reduce LBP and improve walking performance also reduce the chance of falling.

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Acknowledgments

The authors would like to thank Dr. Brian Galinat and the surgeons at the Center of Advanced Joint Replacement at Wilmington Hospital, Christiana Care Health System for their continued support of this project.

Funding

This work was supported by the Department of Orthopedics at Christiana Care Health System and a scholarship from Umm Al-Qura University (Makkah, Saudi Arabia) to Moiyad Aljehani through Saudi Arabian Cultural Mission (SACM).

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Authors and Affiliations

  1. Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA

    Moiyad S. Aljehani

  2. Department of Physical Therapy, Umm Al-Qura University, P.O. Box 715, Makkah, 21421, Saudi Arabia

    Moiyad S. Aljehani

  3. Department of Kinesiology and Applied Physiology, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA

    Jeremy R. Crenshaw

  4. Center for Advanced Joint Replacement, Christiana Care Health Systems, 200 Hygeia Drive, Newark, DE, 19713, USA

    James J. Rubano & Steven M. Dellose

  5. Delaware Orthopaedic Specialists, 1096 Old Churchmans Rd, Newark, DE, 19713, USA

    James J. Rubano & Steven M. Dellose

  6. Department of Rehabilitation and Movement Sciences, Physical Therapy Program North, Rutgers, School of Health Professions, The State University of New Jersey, 65 Bergen Street - Office 714A, Newark, NJ, 07107, USA

    Joseph A. Zeni Jr

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  1. Moiyad S. Aljehani
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  4. Steven M. Dellose
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  5. Joseph A. Zeni Jr
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Contributions

MA: Data collection, data processing, data analysis, and writing and editing of manuscript

JC: Data analysis and writing and/or comprehensive editing of manuscript

JR: Data analysis and writing and/or comprehensive editing of manuscript

SD: Data analysis and writing and/or comprehensive editing of manuscript

JZ: Study conception, study funding, recruitment and enrollment, data interpretation, and writing and editing of manuscript

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Correspondence to Moiyad S. Aljehani.

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Previous Presentation

This work was submitted as an abstract and presented on 2019 at the Combined Section Meeting (CSM), Washington, DC, USA:

- Moiyad Aljehani, Kathleen Madara, James Rubano, Steven Dellose JZ (2019). Falling risk in patients with end-stage knee osteoarthritis. J Orthop Sport Phys Ther. 49(1):CSM3. https://doi.org/10.2519/jospt.2019.49.1.CSM1

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Aljehani, M.S., Crenshaw, J.R., Rubano, J.J. et al. Falling risk in patients with end-stage knee osteoarthritis. Clin Rheumatol 40, 3–9 (2021). https://doi.org/10.1007/s10067-020-05165-6

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