The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review

Abstract

PurposeDespite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature.MethodsA systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool.ResultsThirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III.ConclusionsFindings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II–III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.

Effects of balance training on functional outcomes after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled studies

“…[12] Incomplete proprioceptive recovery of the knee joint, poor mobility and unstable dynamic balance are factors that increase the risk of falls in the elderly, and are also common factors that lead to difficulty in completing daily activities. [13,14] It has been reported that 25% of patients will fall within 2 years after total hip or total knee arthroplasty, [15] resulting in physical and psychological trauma and a high cost to the patient. [16] Therefore, limb balance is particularly important for the basic daily activities and safety of patients with total knee arthroplasty.…”

Does Preoperative Balance Training Reduce Pain and Improve Joint Function in Patients After Total Knee Arthroplasty? A Randomized Controlled Trial

“…[4] TKA has greatly improved the adverse symptoms of the knee, and most patients are satis ed with the e cacy of TKA, [5] however, about 20% of patients still suffer from chronic knee pain after surgery, and 15% of them have not found the exact pathogeny through radiographic images. [6,7] Some patients still have limb imbalance, [8,9] di culties in walking and climbing stairs for a long period of months after surgery, [10,11] as well as some patients have persistent sensorimotor dysfunction, [12] which indicates that part of patients do not achieve the expected physiological function results after TKA.…”

Effectiveness of Balance Exercise Program in Total Knee Arthroplasty: Meta-Analysis

“…Static balance refers to maintaining equilibrium while standing in one place, whereas dynamic balance involves motion and is defined as maintaining equilibrium during locomotion. Falls and loss of balance most commonly occur during movement-related tasks such as walking and less frequently during static activities [4]. Physiological factors such as muscle weakness and impaired postural control and balance has strong association with risk of falls in older people and these may be impaired further with lower limb osteoarthritis.…”