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Falling After a Joint Replacement | www.dailyrx.com.

Falling After a Joint Replacement

Joint replacement patients at risk for hospital falls after surgery

After having a total hip or knee replacement, you’re looking forward to a new and better life. But a having a fall during your period of hospital recovery can really set you back.

Medical researchers at the Hospital for Special Surgery in New York City were alarmed to see an increase in the national prevalence of in-hospital falls following hip or knee replacement surgery.

They wanted to know which patients were more likely to suffer a fall in order to focus preventative efforts on at-risk patients. They found that gender, age, race, and a number of other conditions put patients at higher risk of falls.

If you’re male, older, and a minority, you’re at higher risk of falling after joint replacement surgery.

Dr. Stavros Memtsoudis, an anesthesiologist at Hospital for Special Surgery, led the study. He said that some studies have shown that patients fall when no one is available to assist them as they get up from their beds to go to the bathroom. The study’s goal was to help doctors and hospitals design better programs to reduce the number of easily preventable falls.

A fall is very bad news when you’re recovering from a total hip or knee surgery. In-hospital falls are responsible for prolonging a patient’s time in the hospital, increasing hospital costs and lawsuits against hospitals, and can sometimes result in death. Concussions from falls are not uncommon.

According to current data, 2 to 17 percent of all short-term hospital patients have falls. Not much research has been done regarding falls in orthopedic surgery patients.

The researchers used data from the Nationwide Inpatient Sample, which collects data from around 20 percent of all hospitalizations in the U.S. They narrowed it down to patients who had total hip and knee replacements between 1998 and 2007. A little over 2 patients per every 1,000 in patient days experienced falls, or 0.85 percent of patients had in-hospital falls. They also found that during that period, the number of falls increased.

In terms of risk factors, researchers found that patients were more likely to fall if they were male, older, and a minority, and if they were having a revision of a previous surgery. Patients with congestive heart failure, a clotting or bleeding disorder, liver disease, neurologic disease, electrolyte/fluid abnormalities, and recent weight loss were also at higher risk.

The researchers also found post-operative complicating factors, including deep vein thrombosis, adult respiratory distress syndrome and pulmonary embolism. But it’s not clear if those conditions are the reason or the effect of falls.

The study authors believe this information is very useful to doctors and hospitals. If a patient appears for surgery displaying any of the risk traits, staff would know to look out for the possibility of a fall.

This study was published online in Journal of Arthroplasty in December 2011.

Osteoarthritis

It is estimated that over 27 million people in the United States suffer from some form of osteoarthritis or degenerative disease of the joints. It occurs when the cartilage between moving joints (articular cartilage) degrades or wears away, causing bones to grind together and cause pain, swelling, and stiffness. Bone spurs (extra bone that forms to correct the problem) can also form, causing additional pain and inflammation.

Although it can affect any joints, the ‘weight-bearing’ joints are most often affected, such as the feet, knees, hips, and spine. There is no single known cause, but many factors can predispose a patient to developing osteoarthritis. Old age is a primary risk factor, as is obesity, and previous injury to a joint. Diabetes, other arthritides, ligamentous damage, and inflammatory diseases can also play a role.

Diagnosis is made from patient history and a simple X-ray will reliably show damage. Osteoarthritis cannot be reversed, but treatment options are available. Primary treatments are physical therapy, weight loss (if needed), exercise, and over the counter pain relief (ibuprofen, naproxen). In advanced cases with extreme pain or disability, surgery is a viable option, such as joint replacement (knee, hip, shoulder, feet), spinal fusion, arthroscopy to fix cartilage, and osteotomy to change bone structure.

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