title: Are people following hip and knee arthroplasty at greater risk of experiencing a fall and fracture? Data from the Osteoarthritis Initiative.
abstract: BACKGROUND
  Falls are a major challenge for older people and are a significant source of mortality and morbidity. There has been uncertainty as to whether people with total hip (THA) or knee (TKA) arthroplasty have a greater risk of falls and associated fractures. This analysis was to explore this question with a large community dataset.
  
  
  METHODS
  Data from all people enroled onto the US Osteoarthritis Initiative programme who had undergone a THA (n = 104) or TKA (n = 165), within a 12-month period, were compared to those who had not undergone an arthroplasty (n = 4631). Data were collected on: the number of participants who reported a fall within a 12-month period; the frequency of falls in this period; and whether a fracture was sustained during this period. Odd ratios were calculated for the probability of experiencing a fall or fracture between the groups.
  
  
  RESULTS
  There was no statistical difference in falls between people following THA (OR 0.90; 95 % CI 0.58-1.41) or TKA (OR 0.95; 0.67-1.35) compared to a non-arthroplasty cohort. Whilst there was no statistical difference in fracture risk between people following TKA compared to non-arthroplasty individuals (OR 1.25; 95 % CI 0.57-2.70), those who underwent THA had a 65 % lower chance of experiencing a fracture in the initial 12 post-operative months compared to the non-THA cohort (OR 0.35; 95 % CI 0.19-0.65; p < 0.01).
  
  
  CONCLUSIONS
  There appears a lower chance of experiencing a fracture for people following THA compared to those who have not.
authors.affiliation: Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich Research Park, Queen's Building, Norwich, NR4 7TJ, UK. toby.smith@uea.ac.uk.
authors.forename: T O
authors.initials: TO
authors.lastname: Smith
authors.affiliation: Hinchingbrooke Hospital, Cambridgeshire Community Services, Huntingdon, Cambridgeshire, UK.
authors.forename: M
authors.initials: M
authors.lastname: Pearson
authors.affiliation: St George's Hospital, London, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Latham
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D012306:Risk; D006113:United Kingdom / Q000453:epidemiology
keywords: Community-dwelling; Joint replacement; Lower limb; Osteoarthritis; Rehabilitation; Trauma