Clin Orthop Surg.  2015 Dec;7(4):449-456. 10.4055/cios.2015.7.4.449.

Analyzing the History of Falls in Patients with Severe Knee Osteoarthritis

• Tsonga T
• Michalopoulou M
• Malliou P
• Godolias G
• Kapetanakis S
• Gkasdaris
• Soucacos P

• KMID: 2360258
• DOI: http://doi.org/10.4055/cios.2015.7.4.449

Abstract

BACKGROUND
One out of three adults over the age of 65 years and one out of two over the age of 80 falls annually. Fall risk increases for older adults with severe knee osteoarthritis, a matter that should be further researched. The main purpose of this study was to investigate the history of falls including frequency, mechanism and location of falls, activity during falling and injuries sustained from falls examining at the same time their physical status. The secondary purpose was to determine the effect of age, gender, chronic diseases, social environment, pain elsewhere in the body and components of health related quality of life such as pain, stiffness, physical function, and dynamic stability on falls frequency in older adults aged 65 years and older with severe knee osteoarthritis.
METHODS
An observational longitudinal study was conducted on 68 patients (11 males and 57 females) scheduled for total knee replacement due to severe knee osteoarthritis (grade 3 or 4) and knee pain lasting at least one year or more. Patients were personally interviewed for fall history and asked to complete self-administered questionnaires, such as the 36-item Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and physical performance test was performed.
RESULTS
The frequency of falls was 63.2% for the past year. The majority of falls took place during walking (89.23%). The main cause of falling was stumbling (41.54%). There was a high rate of injurious falling (29.3%). The time patients needed to complete the physical performance test implied the presence of disability and frailty. The high rates of fall risk, the high disability levels, and the low quality of life were confirmed by questionnaires and the mobility test.
CONCLUSIONS
Patients with severe knee osteoarthritis were at greater risk of falling, as compared to healthy older adults. Pain, stiffness, limited physical ability, reduced muscle strength, all consequences of severe knee osteoarthritis, restricted patient's quality of life and increased the fall risk. Therefore, patients with severe knee osteoarthritis should not postpone having total knee replacement, since it was clear that they would face more complicated matters when combining with fractures other serious injuries and disability.

Keyword

Knee osteoarthritis; Falls; Fall risk; Quality of life

MeSH Terms

Accidental Falls/*statistics & numerical data
Aged
Aged, 80 and over
Female
Humans
Longitudinal Studies
Male
Osteoarthritis, Knee/*epidemiology
Quality of Life
Risk

Reference

1. O'Loughlin JL, Robitaille Y, Boivin JF, Suissa S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993; 137(3):342–354.

2. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001; 49(5):664–672.

3. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003; 81(9):646–656.

4. Centers for Disease Control and Prevention (CDC). Prevalence and most common causes of disability among adults: United States, 2005. MMWR Morb Mortal Wkly Rep. 2009; 58(16):421–426.

5. Felson DT, Lawrence RC, Dieppe PA, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000; 133(8):635–646.

6. Foley SJ, Lord SR, Srikanth V, Cooley H, Jones G. Falls risk is associated with pain and dysfunction but not radiographic osteoarthritis in older adults: Tasmanian Older Adult Cohort study. Osteoarthritis Cartilage. 2006; 14(6):533–539.

7. Leveille SG, Jones RN, Kiely DK, et al. Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA. 2009; 302(20):2214–2221.

8. Scott D, Blizzard L, Fell J, Jones G. Prospective study of self-reported pain, radiographic osteoarthritis, sarcopenia progression, and falls risk in community-dwelling older adults. Arthritis Care Res (Hoboken). 2012; 64(1):30–37.

9. Leveille SG, Bean J, Bandeen-Roche K, Jones R, Hochberg M, Guralnik JM. Musculoskeletal pain and risk for falls in older disabled women living in the community. J Am Geriatr Soc. 2002; 50(4):671–678.

10. Hassan BS, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis. 2001; 60(6):612–618.

11. Bellamy N. WOMAC: a 20-year experiential review of a patient-centered self-reported health status questionnaire. J Rheumatol. 2002; 29(12):2473–2476.

12. Hoops ML, Rosenblatt NJ, Hurt CP, Crenshaw J, Grabiner MD. Does lower extremity osteoarthritis exacerbate risk factors for falls in older adults? Womens Health (Lond Engl). 2012; 8(6):685–696.

13. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957; 16(4):494–502.

14. American College of Rheumatology. Timed up and go (TUG) [Internet]. Atlanta, GA: American College of Rheumatology;2015. cited 2015 Sep 21. Available from: http://www.rheumatology.org/I-Am-A/Rheumatologist/Research/Clinician-Researchers/Timed-Up-Go-TUG.

15. The prevention of falls in later life: a report of the Kellogg International Work Group on the prevention of falls by the elderly. Dan Med Bull. 1987; 34:Suppl 4. 1–24.

16. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. conceptual framework and item selection. Med Care. 1992; 30(6):473–483.

17. Parent E, Moffet H. Comparative responsiveness of locomotor tests and questionnaires used to follow early recovery after total knee arthroplasty. Arch Phys Med Rehabil. 2002; 83(1):70–80.

18. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken). 2011; 63:Suppl 11. S208–S228.

19. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000; 80(9):896–903.

20. Levinger P, Menz HB, Morrow AD, et al. Lower limb proprioception deficits persist following knee replacement surgery despite improvements in knee extension strength. Knee Surg Sports Traumatol Arthrosc. 2012; 20(6):1097–1103.

21. Arnold CM, Faulkner RA. The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis. BMC Geriatr. 2007; 7:17.

22. Swinkels A, Newman JH, Allain TJ. A prospective observational study of falling before and after knee replacement surgery. Age Ageing. 2009; 38(2):175–181.

23. Todd C, Skelton D. What are the main risk factors for falls among older people and what are the most effective interventions to prevent these falls? [Internet]. Copenhagen, Denmark: WHO Regional Office for Europe (Health Evidence Network);2004. cited 2015 Sep 21. Available from: http://www.euro.who.int/document/E82552.pdf.

24. Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study. Arch Phys Med Rehabil. 2010; 91(1):106–114.

25. Delbaere K, Close JC, Heim J, et al. A multifactorial approach to understanding fall risk in older people. J Am Geriatr Soc. 2010; 58(9):1679–1685.

26. Maquet PG. Biomechanics of the hip: as applied to osteoarthritis and related conditions. Berlin: Springer-Verlag;1985.

27. Al-Zahrani KS, Bakheit AM. A study of the gait characteristics of patients with chronic osteoarthritis of the knee. Disabil Rehabil. 2002; 24(5):275–280.

28. Berg WP, Alessio HM, Mills EM, Tong C. Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing. 1997; 26(4):261–268.

29. Pijnappels M, van der Burg PJ, Reeves ND, van Dieen JH. Identification of elderly fallers by muscle strength measures. Eur J Appl Physiol. 2008; 102(5):585–592.

30. Kelsey JL, Berry SD, Procter-Gray E, et al. Indoor and outdoor falls in older adults are different: the maintenance of balance, independent living, intellect, and Zest in the Elderly of Boston Study. J Am Geriatr Soc. 2010; 58(11):2135–2141.

31. Marx RG, Jones EC, Atwan NC, Closkey RF, Salvati EA, Sculco TP. Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. J Bone Joint Surg Am. 2005; 87(9):1999–2005.

32. Tsonga T, Michalopoulou M, Malliou P, Godolias G. Quality of life and physical activity after total knee arthroplasty in elderly women. Inq Sport Phys Educ. 2008; 6(1):37–46.

33. Hartley RC, Barton-Hanson NG, Finley R, Parkinson RW. Early patient outcomes after primary and revision total knee arthroplasty: a prospective study. J Bone Joint Surg Br. 2002; 84(7):994–999.

34. Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performancebased and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty. 2011; 26(5):728–737.

35. Baek GH. Are we prepared for geriatric orthopedics? Clin Orthop Surg. 2010; 2(3):129.

36. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005; 35(7):424–436.

37. Alberta Health Services. Timed-Up-and-Go (TUG) test. Edmonton, AB: Alberta Health Services;2015. cited 2015 Sep 21. Available from: http://www.albertahealthservices.ca/ps-1051701-fpp-tug-instructions.pdf.