Incidences and circumstances of falls among women following total hip arthroplasty on long-term follow-up.

BACKGROUND: Patients who undergo total hip arthroplasty have an increased risk of falls during the first postoperative year. However, it is unclear whether patients after total hip arthroplasty will continue to be at high risk of falls more than 1 year postoperatively. To better understand whether the risk of falls changes after a 1-year period, we investigated the incidences and circumstances of falls in women patients for 5 years after total hip arthroplasty. METHODS: This longitudinal prospective cohort study analyzed 65 women with severe hip osteoarthritis who underwent total hip arthroplasty. The incidences and circumstances of falls before total hip arthroplasty and at 1, 2, and 5 years postoperatively were investigated. We assessed the Harris Hip Score and evaluated hip pain and ambulatory ability using a self-administered questionnaire. RESULTS: The incidences of at least one fall were 30.8%, 26.2%, 23.1%, and 30.8% before and 1, 2, and 5 years after surgery, respectively. Among the circumstances of falls from pre-surgery to 5 years post-surgery, there was a significant difference in the direction of falls; however, there were no significant differences in the location, time, cause, and type of injury. Most falls occurred indoors by tripping or loss of balance during the daytime. Among the participants who had falls almost half sustained injuries, and approximately 10% of falls resulted in fractures each year. Although self-reported hip pain, ambulation, and the Harris Hip Score significantly improved in women after total hip arthroplasty compared to pre-surgery, there was no significant difference in the incidences of falls from 1 to 5 years post-surgery. CONCLUSION: Women who underwent total hip arthroplasty continued to have an increased risk of falls and fall-induced injuries for 5 years postoperatively. Preventive measures against falling to reduce fall-induced injuries in the long term are required for women after total hip arthroplasty.

Effects of foam rolling on hip pain in patients with hip osteoarthritis: a retrospective propensity-matched cohort study.

BACKGROUND: Foam rolling is a self-applied massage using a foam roller that has gained popularity for treatment of muscle soreness. However, its efficacy for improving hip pain in patients with hip osteoarthritis remains unclear. OBJECTIVE: To investigate the effects of foam rolling on hip pain in patients with hip osteoarthritis. METHODS: In this retrospective propensity-matched cohort study, medical records of outpatients between January 2017 and March 2019 were reviewed. Of these, 115 patients with hip osteoarthritis were divided into foam rolling or non-foam rolling groups based on home exercises. Both groups were propensity-score matched (1:1) for age, sex, body mass index, Kellgren and Lawrence grade, and visual analog scale (VAS) of hip pain at baseline. The primary outcome was the hip pain-VAS. Effects of interventions on the hip pain-VAS were examined using a split-plot design variance analysis. RESULTS: After matching, both groups comprised 37 patients each. No significant differences were observed in baseline characteristics and outcome measurements between the matched groups. A statistically significant interaction was seen between the effects of time and group for hip pain-VAS (F [1, 72] = 31.874, interaction: P < .001, η2 = 0.307). Hip pain-VAS was improved more effectively in the foam rolling group than those in the non-foam rolling group (P < .001). Thirty-four (92%) patients in the foam rolling group, compared to 15 (41%) in the non-foam rolling group, showed a ≥ 32% (minimal clinically important difference) improvement in hip pain-VAS. CONCLUSION: These results suggested that foam rolling was an effective intervention for improving hip pain in patients with hip osteoarthritis.

Plantar pressure distribution during standing in women with end-stage hip osteoarthritis.

BACKGROUND: Patients with hip osteoarthritis (OA) experience abnormal movement patterns and reduced loading of the affected leg. The plantar contacts the ground and receives force from the ground. Plantar pressure distribution may differ in patients with hip OA compared to healthy adults and may influence physical functioning in these patients. RESEARCH QUESTION: We investigated whether plantar pressure distribution during standing differed between patients with hip OA and healthy adults. We also analyzed the relationship between plantar pressure distribution and walking ability and the factors affecting plantar pressure distribution. METHODS: Maximum plantar pressure distribution during standing for 20 seconds was investigated in patients with hip OA (n = 62; OA group) and in healthy adults (n = 53; Control group). Statistical comparisons between these groups were made using Fisher's exact test and residual analysis. In the OA group, leg length discrepancy, range of hip extension, leg loading, knee extensor strength, and 10 m walking time were assessed; multiple linear regression and logistic regression analyses were used to examine the relationships between these factors and maximum plantar pressure distribution. RESULTS: Maximum plantar pressure distribution was different between the OA and control groups. In the OA group, maximum plantar pressure distribution was one of the significant predictors of 10 m walking time. Additionally, leg length discrepancy was a significant predictor of maximum plantar pressure distribution in this group. SIGNIFICANCE: During standing, the proportion of patients for whom the maximum plantar pressure region was the heel tended to be lower in the group with hip OA compared to the healthy adults. Plantar pressure distribution may have an importance for evaluating walking ability in patients with hip OA. Correcting leg length discrepancy and loading under the heel could adjust plantar pressure distribution in patients with hip OA.

Incidence and Risk Factors for Falls in Women With End-Stage Hip Osteoarthritis.

BACKGROUND AND PURPOSE: Fall-induced injuries and resulting deaths are a serious health problem among older adults. The most common risk factors for falls in older adults are muscle weakness, gait deficiencies, and balance deficits. Patients with end-stage hip osteoarthritis (OA) also have many hip dysfunctions, and these all have the potential to increase the risk of falls. However, the incidence and risk factors for falls in patients with end-stage hip OA remain unclear. The aim of this study was to determine the incidence of falls in women with end-stage hip OA and to identify risk factors for falls in this patient population. METHODS: This study was a cross-sectional analysis. One hundred fifty-three women with end-stage hip OA (mean age = 64.0 years) and 112 age-matched healthy women (mean age = 64.1 years) were analyzed using available data. All participants were examined for the number and circumstances of falls in the past year. The circumstances of falls included the location, time, direction, cause, and injury. We examined the outcome of hip function, ambulatory ability, physical activity, and limping severity in women with end-stage hip OA. Multivariate logistic regression analysis was used to identify factors influencing falls in women with hip OA. RESULTS: The incidence of at least 1 fall in the past year was significantly higher in women with end-stage hip OA (30.1%) than in healthy women (12.5%) (P < .001). Falls in women with end-stage hip OA were most often caused by tripping and falling forward during the daytime. The majority of falls (65.2%) resulted in injuries and 13.0% resulted in fractures. The occurrence of a fall significantly correlated with limping (odds ratio = 3.26, 95% confidence interval = 1.49-7.14, P = .003) and knee extensor muscle strength (odds ratio = 0.22, 95% confidence interval = 0.05-0.85, P = .029). CONCLUSIONS: Women with end-stage hip OA have an increased risk of falls and fall-induced injuries. The prevention of falls in this vulnerable population should be a priority among health care practitioners. In particular, women who are limping and have reduced lower knee extensor strength should take care to avoid falls.

Asymmetrical loading during sit-to-stand movement in patients 1 year after total hip arthroplasty.

BACKGROUND: Asymmetrical loading during functional performance can occur after total hip arthroplasty. We hypothesized that during sit-to-stand movements, the loading of the limbs of patients who undergo total hip arthroplasty is more asymmetrical than that of those who do not. The objective of the present study was to compare asymmetrical loading during the sit-to-stand movements of patients at 1 year after undergoing total hip arthroplasty, and that of healthy adults. METHODS: Twenty-eight patients at 1 year after undergoing total hip arthroplasty and 16 healthy adults were included. We measured the vertical ground reaction force during the sit-to-stand movement for each leg and calculated the ratio of the peak vertical ground reaction force, and the ratio at the time of peak magnitude of the non-operated limb (control, right limb). FINDINGS: The mean peak vertical ground reaction force ratio of the patients was 0.77 (0.2), and it was significantly lower than that of healthy adults. The vertical ground reaction force ratio for these patients at the time of peak magnitude of the non-operated limb was 0.72 (0.2), and was significantly lower than that of healthy adults. INTERPRETATION: Loading on the operated leg during the sit-to-stand movement was lower than that on the non-operated leg in patients at 1 year after undergoing total hip arthroplasty. Furthermore, loading during sit-to-stand movement of patients 1 year after undergoing total hip arthroplasty was more asymmetrical than that of healthy adults. Even at 1 year after undergoing total hip arthroplasty, these patients performed the sit-to-stand movement asymmetrically.

Gait Abnormality Predicts Falls in Women After Total Hip Arthroplasty.

BACKGROUND: Patients who undergo total hip arthroplasty (THA) have an increased risk of falls during the first year postoperatively. However, risk factors for falls after THA remain unclear. We investigated the relationship between gait abnormality and falls during the first year after THA. METHODS: We conducted a prospective cohort study of 286 patients with severe hip osteoarthritis who underwent THA and examined fall history during the first year postoperatively. Baseline characteristics including age, body mass index, number of prescribed medications, comorbidities, and history of falling in the past year were evaluated as covariates and determined using a self-administered questionnaire and interview preoperatively. We assessed functional outcomes, including passive range of motion of the hip joint (flexion, extension, abduction, and adduction), muscle strength (hip abduction and knee extension), gait velocity, and gait abnormality, at 3 weeks postoperatively. Cox proportional hazard regression models were used to analyze the relationship between the presence of gait abnormality and falls. RESULTS: One hundred sixty-two women were included. The incidence of at least 1 fall during the first year after THA was 31.5%. Cox proportional hazard regression models showed that the presence of gait abnormality (hazard ratio, 2.91; 95% confidence interval, 1.55-5.48; P < .001) was significantly associated with falls during the first year postoperatively. CONCLUSION: The presence of gait abnormality is a useful screening tool to predict future falls in women after THA. Clinicians should assess gait abnormality to identify patients who may require fall prevention measures and continuous rehabilitation to improve gait abnormality.

Incidence and Circumstances of Falls in Women Before and After Total Hip Arthroplasty: A Prospective Cohort Study.

BACKGROUND: We investigated the incidence and circumstances related to falls in patients before and after total hip arthroplasty (THA), and compared them with those in an age-matched control group. METHODS: This is a prospective cohort study. A total of 140 women with severe hip osteoarthritis (OA) who underwent THA (OA group) and a control cohort of 319 age-matched healthy women were analyzed. We investigated the incidence and circumstances of falls before THA and during the first year after surgery. We assessed the Harris Hip Score and investigated hip pain and ambulatory ability using a self-administered questionnaire. RESULTS: The incidence of at least one fall during the first year after THA in the OA group (30.0%) was significantly higher than that in the control group (13.5%) (P < .001), as were the rates of indoor falls (50.0%) and falls during daytime (66.2%). Although the incidence of fall-induced injuries after THA (37.8%) was significantly lower than that in the control group (62.5%), 5.9% of patients who experienced a fall developed a fracture. No significant differences were found in the number and circumstances of falls before and after THA, with 31.4% and 30.0% of the OA group reporting at least one fall in the 12 months before and after surgery, respectively. Self-reported pain, ambulation, and Harris Hip Score significantly improved after THA. CONCLUSION: Women undergoing THA have an increased risk of falls during the first year after surgery. Clinicians should suggest preventive measures during rehabilitation to prevent falling in post-THA women.

Leg loading during quiet standing and sit-to-stand movement for one year after total hip arthroplasty.

BACKGROUND: The objective of the present study was to investigate loading of the operated leg during quiet standing and sit-to-stand (STS) movement for 1 year after total hip arthroplasty (THA). METHODS: One hundred and fifty-eight patients with end-stage hip osteoarthritis (OA) who had undergone unilateral primary THA participated in this study. The load distribution on the operated and non-operated legs was computed by measuring the vertical reaction force of the operated and non-operated legs during quiet standing and STS movement. We investigated the load distribution using Pressure Distribution Measurement Platform preoperatively and 1, 2, 3, 6, and 12 months postoperatively. FINDINGS: Loading of the operated leg during quiet standing was restored 1 month postoperatively. Loading of the operated leg during STS movement was higher within 2 months postoperatively than the preoperative levels and continued to increase 1 year postoperatively. Loading of the operated leg was lower during STS movement than that during quiet standing, even 1 year postoperatively. INTERPRETATION: A longitudinal and dynamic assessment of loading of the operated leg after THA is clinically important, and the loading during STS movement might continue to increase for a year after THA.

Fear of Falling Restricts Activities of Daily Living after Total Hip Arthroplasty: A One-Year Longitudinal Study.

OBJECTIVES: To determine the prevalence and time course in changes regarding the fear of falling and whether there are consequent restrictions in activities of daily living (ADL) after total hip arthroplasty (THA). METHODS: This is 1-year longitudinal observational study. We recruited ninety-eight patients before and after THA. Fear of falling was assessed for 12 ADLs preoperatively and postoperatively at 3, 6, and 12 months following THA. In addition, we asked patients to answer whether they had refrained from performing each ADL because of fear of falling. RESULTS: Fifty-two patients were enrolled for the analysis. The total fear of falling score during ADLs decreased with time after THA. The ADLs in which many patients (over 20%) felt fear even at 12 months were using the stairs (25%), sitting and standing from the floor (23%), and walking around the neighborhood (21%). Approximately 10% of patients were restricted in performing ADLs, such as sitting and standing from the floor, because of fear. CONCLUSIONS: Patients undergoing THA frequently experience fear of falling during some ADLs even at 1 year after the operation, which could cause ADL restrictions. CLINICAL IMPLICATIONS: Clinicians should evaluate fear of falling and institute rehabilitation programs individually to decrease excessive fear that might lead to ADL restrictions.