본문 바로가기
KERD
논문KCI 등재

Characterizing patient factors, perioperative interventions, and outcomes associated with inpatients falls after total knee arthroplasty

Ran Schwarzkopf|Kyle W. Lawrence|Lauren Link|Patricia Lavin|Joshua C. Rozell
대한슬관절학회 (Korean Knee Society)|2024.12|Knee Surgery and Related Research|제36권 |pp. 11-11|DOI 10.1186/s43019-024-00215-8

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

FallTourniquetTotal knee arthroplastyPerioperative careAdductor canal block

초록

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.

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.

참고문헌 (39)

  1. Wainwright TW, "Consensus statement for perioperative care in total hip replacement and total knee replacement surgery : Enhanced Recovery After Surgery(ERAS(®))Society recommendations", Acta Orthop, 91(1), pp.3~19 (2020)[DOI]
  2. Morrell AT, "Enhanced recovery after primary total hip and knee arthroplasty : a systematic review", J Bone Joint Surg Am, 103(20), pp.1938~1947 (2021)[DOI]
  3. Ackerman DB, "Postoperative patient falls on an orthopedic inpatient unit", J Arthroplasty, 25(1), pp.10~14 (2010)[DOI]
  4. Johnson RL, "Fall-prevention strategies and patient characteristics that impact fall rates after total knee arthroplasty", Anesth Analg, 119(5), pp.1113~1118 (2014)[DOI]
  5. Meier W, "Total knee arthroplasty : muscle impairments, functional limitations, and recommended rehabilitation approaches", J Orthop Sports Phys Ther, 38(5), pp.246~256 (2008)[DOI]
  6. Holm B, "Loss of knee-extension strength is related to knee swelling after total knee arthroplasty", Arch Phys Med Rehabil, 91(11), pp.1770~1776 (2010)[DOI]
  7. Wasserstein D, "Advanced age, obesity and continuous femoral nerve blockade are independent risk factors for inpatient falls after primary total knee arthroplasty", J Arthroplasty, 28(7), pp.1121~1124 (2013)[DOI]
  8. Nielsen KC, "Femoral nerve blocks", Tech Reg Anesth Pain Manag, 7(1), pp.8~17 (2003)
  9. Sharma S, "Complications of femoral nerve block for total knee arthroplasty", Clin Orthop Relat Res, 468(1), pp.135~140 (2010)[DOI]
  10. Fujita Y, "Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks : a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty", BMC Musculoskelet Disord, 23(1), pp.768~ (2022)[DOI]
  11. Jæger P, "Adductor canal block versus femoral nerve block and quadriceps strength : a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers", Anesthesiology, 118(2), pp.409~415 (2013)[DOI]
  12. Tan Z, "A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage", Medicine, 97(48), pp.e13391~ (2018)[DOI]
  13. Kapoor R, "The saphenous nerve and its relationship to the nerve to the vastus medialis in and around the adductor canal : an anatomical study", Acta Anaesthesiol Scand, 56(3), pp.365~367 (2012)[DOI]
  14. Burckett-St Laurant D, "The nerves of the adductor canal and the innervation of the knee : an anatomic study", Reg Anesth Pain Med, 41(3), pp.321~327 (2016)[DOI]
  15. Chan ACM, "Falls after total knee arthroplasty : frequency, circumstances, and associated factors—a prospective cohort study", Phys Ther, 98(9), pp.767~778 (2018)[DOI]
  16. Thacher RR, "Decreased risk of knee buckling with adductor canal block versus femoral nerve block in total knee arthroplasty : a retrospective cohort study", Arthroplast Today, 3(4), pp.281~285 (2017)[DOI]
  17. Machi AT, "Discharge readiness after tricompartment knee arthroplasty : adductor canal versus femoral continuous nerve blocks—a dual-center, randomized trial", Anesthesiology, 123(2), pp.444~456 (2015)[DOI]
  18. McCarthy Deering E, "Does tourniquet use in TKA increase postoperative pain? A systematic review and meta-analysis", Clin Orthop Relat Res, 477(3), pp.547~558 (2019)[DOI]
  19. Jiang F-Z, "Use of a tourniquet in total knee arthroplasty : a systematic review and meta-analysis of randomized controlled trials", J Orthop Sci Off J Japanese Orthop Assoc, 20(1), pp.110~123 (2015)[DOI]
  20. Jawhar A, "Tourniquet-induced ischaemia during total knee arthroplasty results in higher proteolytic activities within vastus medialis cells : a randomized clinical trial", Knee Surg Sports Traumatol Arthrosc, 24(10), pp.3313~3321 (2016)[DOI]
  21. Dowell D, "CDC clinical practice guideline for prescribing opioids for pain—United States, 2022", MMWR Recomm Rep, 71(3), pp.1~95 (2022)[DOI]
  22. Roof MA, "Inpatient opioid consumption variability following total knee arthroplasty : analysis of 4, 038 procedures", J Knee Surg, 34(11), pp.1196~1204 (2021)[DOI]
  23. Gorlin AW, "Survey of pain specialists regarding conversion of high-dose intravenous to neuraxial opioids", J Pain Res, 9, pp.693~700 (2016)[DOI]
  24. Felson DT, "Knee buckling : prevalence, risk factors, and associated limitations in function", Ann Intern Med, 147(8), pp.534~540 (2007)[DOI]
  25. Matsumoto H, "Fall incidence and risk factors in patients after total knee arthroplasty", Arch Orthop Trauma Surg, 132(4), pp.555~563 (2012)[DOI]
  26. Taniguchi M, "Physical activity mediates the relationship between gait function and fall incidence after total knee arthroplasty", J Knee Surg, 34(11), pp.1205~1211 (2021)[DOI]
  27. Hubler CP, "Liposomal bupivacaine versus standard bupivacaine in the adductor canal for total knee arthroplasty : a randomized", Controll Trial Orthop, 44(4), pp.249~255 (2021)[DOI]
  28. Li D, "Efficacy of adductor canal block combined with additional analgesic methods for postoperative analgesia in total knee arthroplasty : a prospective, double-blind, randomized controlled study", J Arthroplasty, 35(12), pp.3554~3562 (2020)[DOI]
  29. Dennis DA, "Does tourniquet use in TKA affect recovery of lower extremity strength and function? A randomized trial", Clin Orthop Relat Res, 474(1), pp.69~77 (2016)[DOI]
  30. Harsten A, "Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial", Knee, 22(2), pp.126~130 (2015)[DOI]
  31. Zhao H-Y, "The effect of tourniquet uses on total blood loss, early function, and pain after primary total knee arthroplasty : a prospective, randomized controlled trial", Bone Joint Res, 9(6), pp.322~332 (2020)[DOI]
  32. Paravlic AH, "The time course of quadriceps strength recovery after total knee arthroplasty is influenced by body mass index, sex, and age of patients : systematic review and meta-analysis", Front Med, 9, pp.865412~ (2022)[DOI]
  33. Bandholm T, "Physiotherapy exercise after fast-track total hip and knee arthroplasty : time for reconsideration?", Arch Phys Med Rehabil, 93(7), pp.1292~1294 (2012)[DOI]
  34. Levinger P, "Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery", Knee Surg Sports Traumatol Arthrosc, 19(7), pp.1082~1089 (2011)[DOI]
  35. Abdel MP, "Increased aseptic tibial failures in patients with a BMI ≥35 and well-aligned total knee arthroplasties", J Arthroplasty, 30(12), pp.2181~2184 (2015)[DOI]
  36. Berend ME, "Implant migration and failure in total knee arthroplasty is related to body mass index and tibial component size", J Arthroplasty, 23(6 Suppl 1), pp.104~109 (2008)[DOI]
  37. Vazquez-Vela Johnson G, "Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement", J Bone Joint Surg Br, 85(1), pp.52~56 (2003)[DOI]
  38. Hampton CB, "Aseptic loosening at the tibia in total knee arthroplasty: a function of cement mantle quality?", J Arthroplast, 35(6S), pp.S190~S196 (2020)[DOI]
  39. Dalury DF, "Cementless total knee arthroplasty: current concepts review", Bone Joint J, 98-B(7), pp.867~873 (2016)[DOI]

관련 논문AI추천

Preoperative Patient Expectation of Discharge Planning is an Essential Component in Total Knee ArthroplastyAfshin A. Anoushiravani, James E. Feng, Jessica S. Morton, Schwarzkopf Ran, Vivek Singh, William Macaulay, William Petersen대한슬관절학회 · Knee Surgery and Related Research2022 · 제34권 Effects of Tourniquet Use on Quadriceps Function and Pain in Total Knee ArthroplastyDavid Graham, David Liu, Kim Gillies, R. Mark Gillies대한슬관절학회 · Knee Surgery and Related Research2014 · 제26권 제4호A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplastyChristian Thomas Oakley, Joshua C Rozell, Omid S Barzideh, Ran Schwarzkopf, Trevor Simcox, Vivek Singh대한슬관절학회 · Knee Surgery and Related Research2022 · 제34권 Comparison of Short-­Term Complications of General and Spinal Anesthesia for Primary Unilateral Total Knee Arthroplasty박신형, 박용복, 유지수, 이선근, 임수재, 채원석대한슬관절학회 · Knee Surgery and Related Research2017 · 제29권 제2호Impact of time to revision total knee arthroplasty on outcomes following aseptic failureMackenzie Roof, Morteza Meftah, Nathan Lorentz, Ran Schwarzkopf, Shankar Narayanan, Vinay K Aggarwal대한슬관절학회 · Knee Surgery and Related Research2023 · 제35권 Seasonal Influence on Postoperative Complications after Total Knee ArthroplastyArif Ali, Azeem Tariq Malik, Shahid Khan Azmat, Shahryar Noordin, Syed Hamza Mufarrih대한슬관절학회 · Knee Surgery and Related Research2018 · 제30권 제1호

이 간행물의 다른 논문 (47건)

Preserving coronal knee alignment of the knee (CPAK) in unicompartmental knee arthroplasty correlates with superior patient-reported outcomesHyuk‑Soo Han, 윤국로, Sung Eun Kim, 이명철, 이재민pp. 1-1Higher rates of fully preserved posterior cruciate ligament in total knee arthroplasty using a double tibial cut: a prospective randomized controlled trialFrancesca Romana Ripani, Gianluca Cinotti, Giuseppe Giannicola, Giuseppe La Torre, Beatrice Perciballipp. 2-2Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient‑acceptable symptom state (PASS) in patients who have undergone total knee arthroplasty: a systematic reviewFilippo Migliorini, Nicola Maffulli, Luise Schäfer, Ulf Krister Hofmann, Andreas Bell, Francesco Simeonepp. 3-3Enhanced deep learning model enables accurate alignment measurement across diverse institutional imaging protocols남준우, 김종근, 김중일, Sung Eun Kim, 노두현pp. 4-4Efficacy and safety of different bupivacaine concentrations in periarticular infiltration combined with adductor canal block for bilateral total knee arthroplasty: a randomized controlled trialSukanya Dej‑arkom, Rapeepat Narkbunnam, Somruedee Chatsirichareonkul, Weerawadee Chandranipapongse, Pawinee Pangthipampai, Arissara Iamaroon, Suwida Tangchittam, Keerati Charoencholvanichpp. 5-5
원문 보기