di Laura Frattura Giorgio, Filardo Giuseppe, Giunchi Dario, Fusco Augusto, Zaffagnini Stefano, Candrian Christian
Ospedale Regionale di Lugano - EOC - Via Tesserete, 46 - Lugano, Switzerland.
Rizzoli Orthopaedic Institute - Via Di Barbiano, 1/10 - Bologna, Italy.
J Orthop. 2018 Aug 24;15(3):903-908. doi: 10.1016/j.jor.2018.08.026. eCollection 2018 Sep.
Falls occur frequently in patients with impaired ambulation and may dramatically affect the elderly population. Aim was to document the incidence of falls in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA), and to identify factors and treatments that may influence the risk of falls.
A systematic literature search was conducted on three medical electronic databases, PubMed, PeDRO, and Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used. Risk of bias analysis and best evidence synthesis were performed. The main aspects related to falls were analyzed: prevalence, risk factors, correlation with clinical outcome, effect of treatments.
The systematic review identified 11 papers on 1237 patients. Pre-operative fall prevalence ranged from 23% to 63%, while post-operative values ranged from 12% to 38%. Moderate evidence was found on no influence of clinical scales, no BMI differences between "faller" and "non-faller", and on influence of limited pre-operative range of motion. Conflicting evidence was found for sex, history of previous falls, age, kyphosis, muscle weakness, fear of falling, depression, balance, gait impairment. No evidence was found for the effectiveness of surgical or rehabilitative strategies on falls reduction.
OA patients undergoing TKA are at high risk of falls, which is reduced but still present after surgery. Although some risk factors were identified, there are no studies demonstrating the possibility of reducing the incidence of this deleterious event, which warrants further research efforts to better manage this fragile population of elderly patients.
行动不便的患者经常跌倒，这可能会对老年人群产生重大影响。本研究旨在记录接受全膝关节置换术（TKA）的膝骨关节炎（OA）患者的跌倒发生率，并确定可能影响跌倒风险的因素和治疗方法。
在三个医学电子数据库PubMed、PeDRO和Cochrane协作网进行了系统的文献检索。采用系统评价和Meta分析的首选报告项目指南。进行了偏倚风险分析和最佳证据综合。分析了与跌倒相关的主要方面：患病率、危险因素、与临床结局的相关性、治疗效果。
系统评价纳入了11篇关于1237例患者的论文。术前跌倒患病率在23%至63%之间，而术后在12%至38%之间。有中等证据表明临床量表无影响、“跌倒者”和“非跌倒者”之间BMI无差异以及术前活动范围受限有影响。在性别、既往跌倒史、年龄、脊柱后凸、肌肉无力、害怕跌倒、抑郁、平衡、步态障碍方面发现了相互矛盾的证据。未发现手术或康复策略对降低跌倒有效。
接受TKA的OA患者跌倒风险很高，术后虽有所降低但仍然存在。尽管确定了一些危险因素，但尚无研究表明有可能降低这一有害事件的发生率，这需要进一步研究以便更好地管理这一脆弱的老年患者群体。
