Matsumoto Hiromi, Okuno Makoto, Nakamura Tatsuhiko, Yamamoto Kichizo, Osaki Mari, Hagino Hiroshi
Rehabilitation Division, Tottori University Hospital, Yonago 683-8504, Japan.
†Clinical Department of Orthopedic Surgery, Hakuai Hospital, Yonago 683-0853, Japan.
Yonago Acta Med. 2014 Dec;57(4):137-45. Epub 2014 Dec 26.
It is possible that patients who have undergone total knee arthroplasty (TKA) are at a high risk of falling. However, there are insufficient data to confirm the incidence and risk factors for falling in patients after TKA compared with healthy elderly counterparts. The purpose of this study was to elucidate the incidence and risk factors for falling in patients after TKA compared to the age- and gender-matched healthy elderly.
Subjects who underwent TKA consisted of 252 patients over 60 years of age. Controls were 150 healthy elderly individuals over 60 years of age living independently in the community. A self-administered questionnaire was mailed to patients after TKA and a similar questionnaire was distributed to the controls by investigators during the town-sponsored healthy aging program. The questionnaire included questions for ambulatory ability, functional status in daily living, knee pain, other joint pain and information on falls.
Self-administered questionnares were returned by 192 of the 252 patients (76.1%) and 146 of the 150 controls (97.3%). Age and gender matching was performed for respondents between 70 and 80 years of age. There were 81 patients and 80 controls who fulfilled the inclusion criteria, and all of them agreed to participate. In the previous year, 34 of the 81 patients (38.2%) fell. The incidence of falls was significantly higher in patients than controls (23.8%, P = 0.041). In controls, ability to stand up from a chair without using the arms and restriction from joining social activities due to knee pain showed the strongest association with recent falls. In patients, self-reported kyphosis showed the strongest association with recent falls.
Patients after TKA are more likely to fall than the general Japanese population. Kyphosis showed the strongest association with recent falls in patients after TKA, which was different from the results obtained in the healthy elderly.
接受全膝关节置换术（TKA）的患者可能存在较高的跌倒风险。然而，与健康的老年人群相比，目前尚无足够数据证实TKA术后患者跌倒的发生率及危险因素。本研究的目的是阐明TKA术后患者与年龄和性别匹配的健康老年人相比跌倒的发生率及危险因素。
接受TKA的受试者为252例60岁以上患者。对照组为150名60岁以上独立生活在社区的健康老年人。在TKA术后向患者邮寄一份自填式问卷，在城镇主办的健康老龄化项目期间，由研究人员向对照组发放类似问卷。问卷包括有关行走能力、日常生活功能状态、膝关节疼痛、其他关节疼痛以及跌倒信息的问题。
252例患者中有192例（76.1%）返回了自填式问卷，150名对照组中有146例（97.3%）返回了问卷。对年龄在70至80岁之间的受访者进行了年龄和性别匹配。有81例患者和80名对照符合纳入标准，他们均同意参与。在过去一年中，81例患者中有34例（38.2%）跌倒。患者跌倒的发生率显著高于对照组（23.8%，P = 0.041）。在对照组中，不借助手臂从椅子上站起来的能力以及因膝关节疼痛而限制参加社交活动与近期跌倒的关联最强。在患者中，自我报告的脊柱后凸与近期跌倒的关联最强。
TKA术后患者比一般日本人群更容易跌倒。脊柱后凸与TKA术后患者近期跌倒的关联最强，这与健康老年人的结果不同。
