THA and TKA Reduce the Risk of Future Falls in Patients with OA, Study Finds
Patients who undergo total hip or knee arthroplasty to treat osteoarthritis (OA) can generally expect excellent long-term outcomes, with decreased pain and improved mobility. But does surgery put them at greater risk for traumatic falls, as some researchers have suggested, than patients with OA who did not undergo a total joint procedure?
Probably not: Researchers from NYU Langone Health compared fall rates in nearly 500,000 patients with hip and knee OA in the Statewide Planning and Research Cooperative System (SPARCS) New York database and found in those who underwent a total hip or total knee arthroplasty between 2000 and 2015 had a significantly lower number of falls postoperatively than patients who did not undergo surgery.
These findings were recently published in the Journal of the American Academy of Orthopaedic Surgeons.
Patients with the primary diagnosis of lower extremity OA were divided into 4 categories:
- 168,234 patients with hip OA who underwent total hip arthroplasty (THA)
- 22,482 patients with hip OA who did not undergo THA
- 275,651 patients with knee OA who underwent total knee arthroplasty (TKA)
- 32,826 patients with knee OA who did not undergo TKA
The researchers compared fall rates between the 2 hip groups and between the 2 knee groups. They used Cox proportional hazards models to determine the relationship between demographics and clinical characteristics and the risk of falls after a hip or knee OA diagnosis, reporting the results as hazard ratios (HR) with 95% confidence intervals (95% CI). To avoid bias, any falls in the first 90 days of recovery from surgery were excluded from the statistical models.
The fall rates were found to be significantly lower among patients who underwent THA or TKA than among patients who opted not to have surgery: HR 0.56 for THA (95% CI, 0.48 to 0.66) and HR 0.66 for TKA (95% CI, 0.57 to 0.76).
“We looked at how many people from each group came into a hospital to seek care for their fragility fracture, due to a fall, and found that those who had [total joint arthroplasty] fell far less than those who did not,” said senior author Ran Schwarzkopf, MD, MSc, from NYU Langone Health. “From that, we concluded that [total joint arthroplasty] for patients that have OA is protective against future falls.”
Aside from reduced pain and increased mobility, patients who undergo THA or TKA also have less fear of experiencing a fall, leading to greater stability and confidence in their daily movements, Dr. Schwarzkopf said.
“[Total joint arthroplasty] will allow patients to go back to the daily activities they may have avoided due to pain and restricted range of motion,” he said. “They are able to go back to the point in their lives when they can do activities, such as hiking, riding a bicycle or even walking their dog, without having to think about whether it will cause them physical pain or rely as heavily on ambulatory aids and caregivers.”
Driesman A, Paoli AR, Wiznia DH, et al. Total joint arthroplasty is associated with a decreased risk of traumatic falls: an analysis of 499,094 cases. J Am Acad Orthop Surg. 2020 Oct 15;28(20):838-846. doi: 10.5435/JAAOS-D-19-00541.