Prevalence of fall in patients with total knee arthroplasty living in the community
Soison, A.; Riratanapong, S.; Chouwajaroen, N.; Chantowart, C.; Buranapiyawong, L.; Kaewkot, S.; Kosuwon, W.
Journal of the Medical Association of Thailand 97(12): 1338-1343
2014
ISSN/ISBN: 0125-2208 PMID: 25764643 Document Number: 16755
To study post-operative pain and blood loss after intraoperative periarticular injection with the multimodal drugs diclofenac, adrenaline, marcaine (bupivacaine) and morphine in total knee arthroplasty. A prospective randomized controlled trial of knee osteoarthritis patients age more than 55 years undergoing total knee arthroplasty at Maharat Nakhon Ratchasima hospital from January 2011 through June 2012 was performed. A group receiving intra-operative periarticular injections was compared to a control group receiving no injections. Half of a group of forty-two patients, 2 males and 40 females, average age 67.9 years (range 57-84 years), were randomly assigned to receive the periarticular injection (the injection group), the others to the control group. Pain was measured by two methods: visual analog score at 6, 12, 24 and 48 hours post-operation and by patient controlled analgesia (PCA) measuring the daily amount of intravenous morphine used. The amount of blood loss post operation (in the redivac drain), degree of knee flexion, time to onset of assisted ambulation, length of hospital stay and any complications were also analyzed. The mean VAS at 6 and 12 hours post operation of the injection group were 2.67 and 2.48, whereas the values for the control group were 6.10 and 4.95, respectively (p < 0.05). Mean quantities of morphine used by PCA by the injection group during the first day was 9.43 mg, significantly lower than the 18.81 mg used by the control group. Average blood loss of the injection group at 263.8 ml was also significantly below the 362.1 ml of the control group (p < 0.05). The degree of knee flexion, time to onset of assist ambulation, length of hospital stay and complications, however were not significantly different between the groups. Multimodal drugs, periarticular injections consisting of diclofenac, adrenaline, Marcaine plus a patient controled anesthetic machine (PCA) with morphine can significantly reduce post-operative pain and blood loss in total knee arthroplasty without significant adverse effects. Knee osteoarthritis (OA) with pain, stiffness and functional limitations is associated with risk of falls. Total knee arthroplasty (TKA) is an effective treatment for OA knee and affords significant improvements in pain, function and proprioception. Many studies have shown proprioceptive/balance deficits and decreases in knee extension strength following TKA, which could increase risk of falls. To identify the prevalence rate andfall-risk in Thai TKA patients. A cross-sectional study was conducted among patients with TKA diagnosed with primary OA who living in the community. There were 54 patients (46 females, 8 males). Mean time between surgery and interview was 38.9 ± 16.6 (7-73) months. The one-year prevalence of falls among patients was 42.6% (23/54 patients): total frequency was 34 times (1-4 times/case). Three fallers needed treatment: one by open reduction and internal fixation with plate and screws of periprosthetic fracture of the femur, and the others needed hospitalization due to hemathrosis of non-TKA knees. The WOMAC pain and stiffness scores were significantly higher in the faller group than the non-faller group. Limitation of joint motion was the main fall-risk factor (OR 6.3; 95% CI 1-67.2, p < 0.05). The prevalence rate offalls for this group of TKA patients was about 42%. Limited motion and pain of the knee joint were associated with falls in this study group.
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