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Lawrence KW, Link L, Lavin P, Schwarzkopf R, Rozell JC. Characterizing patient factors, perioperative interventions, and outcomes associated with inpatients falls after total knee arthroplasty. Knee Surg Relat Res 2024; 36:11. [PMID: 38459532 PMCID: PMC10924359 DOI: 10.1186/s43019-024-00215-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Mechanical falls represent a potential adverse event after total knee arthroplasty (TKA) and may introduce further injury and delay postoperative recovery. This study aimed to identify patient characteristics associated with inpatient falls, to determine the impact of inpatient falls on surgical outcomes following TKA, and to describe the relationship between tourniquet and/or adductor canal block (ACB) use and fall rates. METHODS Patients undergoing primary, elective TKA at a single institution between 2018 and 2022 were retrospectively analyzed. Patients were stratified into groups based on whether they sustained a postoperative inpatient fall or not. Perioperative characteristics, lengths of stay (LOS), rates of 90-day readmissions, and revisions were compared, and fall characteristics were described. Subanalysis was conducted comparing fall incidence based on tourniquet and/or ACB use. RESULTS In total 6472 patients were included with 39 (0.6%) sustaining falls. Falls most commonly occurred on postoperative days one (43.6%) and two (30.8%), and were most commonly due to loss of balance (41.9%) or buckling (35.5%). Six (15.4%) fall patients sustained minor injuries, and one (2.6%) sustained major injury (malleolar fracture requiring non-operative orthopaedic management). The LOS (3.0 ± 1.5 vs 2.3 ± 1.5 days, p = 0.002) and all-cause revision rates at latest follow-up (10.3% vs. 2.0%, p = 0.008) were significantly higher in the fall group. Falls were comparable across subgroups based on tourniquet and/or ACB use (p = 0.429). CONCLUSION Patients who fell had a longer LOS and higher revision rate postoperatively. Rates of inpatient falls were comparable regardless of tourniquet and/or ACB use. Concern for inpatient falls should not influence surgeons when considering the use of tourniquets and/or ACBs, though well-designed, large-volume, prospective randomized studies are warranted to better understand this relationship.
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Affiliation(s)
- Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Lauren Link
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Patricia Lavin
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA.
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Sato Y, Taniguchi M, Fukumoto Y, Okada S, Wang Z, Nakazato K, Niiya N, Yamada Y, Kimura M, Ichihashi N. Age-related change in gait efficacy and predictors of its decline: A 3-year longitudinal study. Geriatr Gerontol Int 2024; 24:90-94. [PMID: 38102928 DOI: 10.1111/ggi.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
AIM This study aimed to calculate the minimal clinically important difference (MCID) for a modified Gait Efficacy Scale (mGES) over 3 years and to clarify the predictors of mGES decline. METHODS In total, 87 community-dwelling older adults were enrolled in this 3-year longitudinal study. The mGES, fall history and physical function (chair stand frequency, open-eyes one-leg stand, open-close stepping test, walking speed, walking endurance [shuttle stamina walk test] and physical activity) were assessed at baseline. After a 3-year follow-up period, the mGES and Global Rating of Change Scale were assessed. The MCID was calculated using anchor-based methods, with the Global Rating of Change Scale as an anchor. The participants were classified into the decline and keep groups based on whether the changes in the mGES were greater than the MCID. A logistic regression analysis was conducted using the mGES as the dependent variable and physical characteristics, fall history, and physical function as independent variables. RESULTS The MCID for the mGES over 3 years was -7.38 points. A logistic regression analysis identified low open-close stepping (odds ratio, 0.87; 95% confidence interval, 0.782-0.985; P = 0.027) and the shuttle stamina walk test (odds ratio, 0.974; 95% confidence interval, 0.949-1.000; P = 0.049) as predictors of the mGES decline. CONCLUSION These findings suggest that a change of 7.38 points in the mGES was clinically significant and that poor agility and walking endurance can predict future decline in the mGES. Geriatr Gerontol Int 2024; 24: 90-94.
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Affiliation(s)
- Yu Sato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihiro Fukumoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Shogo Okada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Research Fellow of the Japan Society for the Promotion of Science, Chiyoda-ku, Japan
| | - Zimin Wang
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Research Fellow of the Japan Society for the Promotion of Science, Chiyoda-ku, Japan
| | - Kaede Nakazato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nanami Niiya
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Yamada
- National Institutes of Biomedical Innovation, Health and Nutrition, Ibaraki, Japan
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kameoka, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Muacevic A, Adler JR. Does Total Knee Arthroplasty Positively Affect Body Static-Dynamic Balance and Fall Risk Parameters in Patients With Satisfactory Functional Scores? Cureus 2022; 14:e30207. [PMID: 36246086 PMCID: PMC9557240 DOI: 10.7759/cureus.30207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The aim of this study was to determine the balance problems and risk of falling by using digital or computerized methods in patients who underwent total knee arthroplasty (TKA) and have satisfactory functional scores in the early postoperative period. Methodology A total of 31 participants (24 women, seven men; mean age: 61.93 ±10.75 years; range: 49-82 years) who underwent unilateral TKA were included. The fall risk was evaluated using the time up-and-go (TUG) test and computerized platforms. Patient-reported pain, stiffness, and physical functional outcome measures [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS)] and posture (New York Posture Rating Chart) were evaluated. Results Based on the WOMAC scores, there was a significant impact on self-reported pain (p˂0.001), function (p=0.001), and stiffness (p=0.001) between preoperative and postoperative results. The OKS (p=0.006) and the TUG score (p=0.004) improved significantly, but the posture scores remained the same after the surgery. There was a statistically significant difference between the preoperative and third-month postoperative test results of the stabilometric test, bipedal opened eye, bipedal closed eye, monopedal right, and monopedal left foot static balance tests (p˂0.05). However, the disequilibrium and equilibrium dynamic balance values remained unchanged three months after TKA. Conclusions Satisfactory functional scores according to WOMAC or OKS were achieved in the early postoperative period. However, posture and dynamic balance problems related to falling risk continued to persist in the same period. Although the TUG test results were statistically significant, they also showed fall risk values. Fall risk and postural problems should be analyzed objectively using computerized methods. Early rehabilitation programs after TKA in elderly individuals should be designed accordingly and close attention must be paid to fall risks.
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Tang D, Cai W, Yang W, Chen S, Li L. Effectiveness of Health-Related Behavior Interventions on Physical Activity-Related Injuries in Junior Middle School Students. Int J Environ Res Public Health 2022; 19:4049. [PMID: 35409732 PMCID: PMC8997892 DOI: 10.3390/ijerph19074049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 02/05/2023]
Abstract
The objective of this study was to determine the effectiveness of an intervention program based on Health-Related Behavior Theory (HRBT) in reducing physical activity-related injuries (PARIs) occurrence and individual risk-taking behaviors, as well as improving PA-related behaviors. A total of 1044 students from six junior middle schools in Shantou city were included and divided randomly into an intervention group (n = 550) and a control group (n = 494), respectively. The intervention group followed a prescribed PARIs intervention program based on HRBT, and the control group performed a common health education program, consisting of seven sessions and lasting seven months from May to November 2018. After the intervention, both groups showed a significantly lower prevalence of PARIs (intervention group: from 25.45% to 10.91%, control group: from 29.76% to 11.74%, both p < 0.05), but no significant between-group differences could be observed in the post-intervention PARIs prevalence (p > 0.05). Compared with the control group, students in the intervention group had a higher improvement in PA-related behaviors and a lower score of risk-taking behaviors (both p < 0.05). Thus, it could be concluded that the HRBT intervention program had a positive effect on PA-related and risk-taking behaviors in junior middle school students, though its effectiveness in reducing the occurrence of PARIs was not significant.
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Affiliation(s)
- Dongchun Tang
- School of Public Health, Shantou University, Shantou 515041, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China
- Department of Non-communicable Diseases Control, Futian District Institute for Prevention and Control of Chronic Diseases, Shenzhen 518048, China
| | - Weicong Cai
- School of Public Health, Shantou University, Shantou 515041, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China
- Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
| | - Wenda Yang
- School of Public Health, Shantou University, Shantou 515041, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China
| | - Shangmin Chen
- School of Public Health, Shantou University, Shantou 515041, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China
| | - Liping Li
- School of Public Health, Shantou University, Shantou 515041, China
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Mooiweer Y, van den Akker-Scheek I, Stevens M. Amount and type of physical activity and sports from one year forward after hip or knee arthroplasty-A systematic review. PLoS One 2021; 16:e0261784. [PMID: 34962967 PMCID: PMC8714096 DOI: 10.1371/journal.pone.0261784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION After rehabilitation following total hip or knee arthroplasty (THA/TKA), patients are advised to participate in physical activity (PA) and sports. However, profound insight into whether people adopt a physically active lifestyle is lacking. Aim is to gain insight into the performed amount and type of PA (including sports) and time spent sedentarily by persons after THA/TKA. METHODS A systematic review (PROSPERO: CRD42020178556). Pubmed, Cinahl, EMBASE and PsycInfo were systematically searched for articles reporting on amount of PA, and on the kind of activities performed between January 1995-January 2021. Quality of the articles was assessed with the adapted tool from Borghouts et al. RESULTS The search retrieved 5029 articles, leading to inclusion of 125 articles reporting data of 123 groups; 53 articles reported on subjects post-THA, 16 on post-hip-resurfacing arthroplasty, 40 on post-TKA, 15 on post-unicompartimental knee arthroplasty and 12 on a mix of arthroplasty types. With respect to quality assessment, 14 articles (11%) met three or fewer criteria, 29 (24%) met four, 32 (26%) met five, 42 (34%) met six, and 6 (5%) met seven out of the eight criteria. PA levels were comparable for THA and TKA, showing a low to moderately active population. Time spent was mostly of low intensity. Roughly 50% of -subjects met health-enhancing PA guidelines. They spent the largest part of their day sedentarily. Sports participation was relatively high (rates above 70%). Most participation was in low-impact sports at a recreational level. Roughly speaking, participants were engaged in sports 3 hours/week, consisting of about three 1-hour sessions. CONCLUSION Activity levels seem to be low; less than half of them seemed to perform the advised amount of PA following health-enhancing guidelines Sports participation levels were high. However, many articles were unclear about the definition of sports participation, which could have led to overestimation.
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Affiliation(s)
- Yvet Mooiweer
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Ninomiya K, Takahira N, Ikeda T, Suzuki K, Sato R, Kazuo H. Prevalence of frailty and associated factors among community-dwelling older adults after total hip arthroplasty. Hip Int 2021; 33:397-403. [PMID: 34569345 DOI: 10.1177/11207000211048180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the prevalence of frailty and associated factors among community-dwelling older adults who have undergone total hip arthroplasty (THA). MATERIALS AND METHODS This study, which employed a cross-sectional, observational design, was conducted between April and November 2020. The participants were older adults (⩾65 years) who had undergone primary THA at the study hospital. Based on Fried's modified phenotype, frailty was stratified into 3 degrees according to the presence of 3 or more of the following components: weight loss, weakness, exhaustion, low activity level, and slow walking speed. Multinomial logistic regression was used to analyse the associations of frailty with its potential risk factors. RESULTS The data of 518 participants were analysed. The overall prevalence of frailty and prefrailty was 11.4% and 51.0%, respectively. The multinomial logistic regression analysis showed that calf circumference (odds ratio [OR] 0.716, 95% confidence interval [CI], 0.611-0.839; p < 0.001), fall history (OR 2.435, 95% CI, 1.114-5.322; p = 0.026), hip abductor muscle strength (OR 0.962, 95% CI, 0.938-0.987; p = 0.003), knee extensor muscle strength (OR 0.980, 95% CI, 0.964-0.996; p = 0.013), and Timed Up and Go test (TUG) performance (OR 1.802, 95% CI, 1.458-2.228; p < 0.001) were associated with frailty. CONCLUSIONS Frailty was highly prevalent in community-dwelling older adults after THA. Further, its potential associations with calf circumference, hip abductor and knee extensor muscle strength, TUG performance, and fall history highlight the significance of these factors for interventions.
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Affiliation(s)
- Kazunari Ninomiya
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Centre, Kanagawa, Japan.,Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Naonobu Takahira
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Takashi Ikeda
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Centre, Kanagawa, Japan.,School of Nursing and Rehabilitation Sciences, Showa University, Kanagawa, Japan
| | - Koji Suzuki
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Centre, Kanagawa, Japan
| | - Ryoji Sato
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Centre, Kanagawa, Japan
| | - Hirakawa Kazuo
- Department of Orthopaedic Surgery, Shonan Kamakura Joint Reconstruction Center, Kamakura, Kanagawa
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Barone G, Zinno R, Pinelli E, Benvenuti F, Bragonzoni L; Pair Study Group. Evaluation of the Efficacy and Safety of an Exercise Program for Persons with Total Hip or Total Knee Replacement: Study Protocol for a Randomized Controlled Trial. Int J Environ Res Public Health 2021; 18:6732. [PMID: 34201439 DOI: 10.3390/ijerph18136732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Total hip replacement (THR) and total knee replacement (TKR) are among the most common elective surgical procedures. There is a large consensus on the importance of physical activity promotion for an active lifestyle in persons who underwent THR or TKR to prevent or mitigate disability and improve the quality of life (QoL) in the long term. However, there is no best practice in exercise and physical activity specifically designed for these persons. The present protocol aims to evaluate the efficacy and safety of an exercise program (6 month duration) designed for improving quality of life in people who had undergone THR or TKR. This paper describes a randomized controlled trial protocol that involves persons with THR or TKR. The participant will be randomly assigned to an intervention group or a control group. The intervention group will perform post-rehabilitation supervised training; the control group will be requested to follow the usual care. The primary outcome is QoL, measured with the Short-Form Health Survey (SF-36); Secondary outcomes are clinical, functional and lifestyle measures that may influence QoL. The results of this study could provide evidence for clinicians, exercise trainers, and policymakers toward a strategy that ensures safe and effective exercise physical activity after surgery.
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