A prospective observational study of falling before and after knee replacement surgery.

BACKGROUND knee arthritis is a risk factor for falling. Increasing numbers of people are receiving total knee arthroplasty (TKA) but the natural history of falling before and after TKA is unknown. OBJECTIVE to prospectively monitor falls in pre- and post-operative TKA patients and to identify independent risk factors for post-operative falling. DESIGN a prospective observational study with a 1-year follow-up. PARTICIPANTS community-dwelling older people recruited from a regional orthopaedic centre. METHODS consecutive patients added to the TKA waiting list who completed monthly falls diaries, pre-operatively and 1 year post-operatively. Data on knee status (WOMAC: pain, stiffness and function), balance confidence (the Activities Balance Confidence Scale-UK-ABC-UK) and mood (Geriatric Depression Scale-GDS) were collected at quarterly intervals. RESULTS ninety-nine patients received a primary TKA. 24.2% fell in the last pre-operative quarter (24 patients reported 44 falls) and this decreased to 11.7-11.8% in the first four post-operative quarters. 45.8% of people who fell pre-operatively fell again in the first post-operative year. Higher pre-operative GDS scores and a history of falling were significant independent predictors of post-operative falling. CONCLUSION a recent history of falling is common in people undergoing TKA and approximately 45% of patients fall again in the year following surgery. Patients being considered for TKA should be asked about falls history and undergo falls risk assessment and intervention.