KSSTA - 2026-06-22 - Journal Article
Preoperative fall history is associated with increased postoperative complications at 2 years after primary total knee arthroplasty: A propensity-matched analysis.
Kang H, Ilyas MH, Freeman IA, Sampson WT, Mannina CM, Kwon YM
Topics
Key Takeaway
Preoperative fall history in TKA patients ≥65 years is associated with nearly double the 2-year revision rate (2.8% vs. 1.8%), 1.8× higher PJI rate (2.8% vs. 1.7%), and 82% higher postoperative fall rate (15.3% vs. 8.4%) compared to propensity-matched controls.
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Summary
This study asked whether a documented preoperative fall history (ICD-coded, within 1 year of surgery) independently predicts worse outcomes after primary TKA in patients ≥65 years. Using a federated health network with 1:1 propensity matching on age, sex, BMI, medications, and modified frailty index, the fall cohort demonstrated significantly higher 90-day ED visits (19.2% vs. 12.1%), readmissions (11.9% vs. 8.7%), and SSI (0.8% vs. 0.4%), as well as higher 2-year revision (2.8% vs. 1.8%), PJI (2.8% vs. 1.7%), periprosthetic fracture (1.0% vs. 0.6%), and mortality (3.3% vs. 2.3%). All differences reached statistical significance (p≤0.01), establishing preoperative fall history as an independent risk factor beyond standard frailty metrics.
Key Limitation
Retrospective ICD-code ascertainment of falls introduces significant misclassification bias, as undercoded or unreported falls would contaminate the control group and attenuate the true magnitude of risk differences.
Original Abstract
PURPOSE
Falls are common in patients with advanced knee osteoarthritis undergoing total knee arthroplasty (TKA), with the reported preoperative prevalence ranging from 23% to 63%, and may reflect frailty and functional impairment that could influence postoperative outcomes. However, the potential association between a documented preoperative fall history and postoperative outcomes after primary TKA remains unclear. This study aimed to compare 90-day, 1-year and 2-year TKA outcomes in propensity-matched patients aged ≥65 years with and without a documented preoperative fall history.
METHODS
A federated research health network was queried to identify patients aged ≥65 years who underwent primary TKA with at least 2 years of follow-up. Preoperative fall history was defined by International Classification of Diseases codes within 1 year before TKA. We performed 1:1 nearest-neighbour propensity score matching on age, sex, body mass index, medications and modified frailty index variables yielding 7000 patients per group. Continuous variables were compared using independent t-tests, and categorical variables were compared using chi-square or Fisher exact tests. The 90-day and 1- and 2-year outcomes were evaluated.
RESULTS
Compared with matched controls, patients with preoperative falls had higher 90-day postoperative falls (6.4% vs. 1.7%), emergency department visits (19.2% vs. 12.1%), readmissions (11.9% vs. 8.7%), surgical site infections (0.8% vs. 0.4%) and medical complications (all p < 0.05). The falls cohort had higher postoperative falls (1-year: 9.5% vs. 4.2%; 2-year: 15.3% vs. 8.4%), revision (1-year: 2.1% vs. 1.2%; 2-year: 2.8% vs. 1.8%), periprosthetic joint infection (1-year: 2.3% vs. 1.4%; 2-year: 2.8% vs. 1.7%), periprosthetic fracture (1-year: 0.7% vs. 0.4%; 2-year: 1.0% vs. 0.6%) and 2-year mortality (3.3% vs. 2.3%) (all p ≤ 0.01).
CONCLUSION
A history of one or more falls within the year preceding surgery was associated with increased 90-day complications and higher 1- and 2-year risks of adverse surgical outcomes and mortality. These findings support incorporating fall history into routine preoperative risk stratification and targeted perioperative optimisation and follow-up strategies for patients at increased risk.
LEVEL OF EVIDENCE
Level III.