title: The effect of total knee arthroplasty on patients' balance and incidence of falls: a systematic review.
abstract: OBJECTIVE
  Despite 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Thirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III.
  
  
  CONCLUSIONS
  Findings 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.
authors.affiliation: Department of Physiotherapy, Branch Department of Aigion, Technological Educational Institute (TEI) of Western Greece, Psaron 6, 25100, Aigion, Greece. moutzouri_marie@yahoo.com.|Queen Margaret University, Musselburgh, UK. moutzouri_marie@yahoo.com.
authors.forename: M
authors.initials: M
authors.lastname: Moutzouri
authors.affiliation: School of Health Sciences, Queen Margaret University, Musselburgh, UK.
authors.forename: N
authors.initials: N
authors.lastname: Gleeson
authors.affiliation: Department of Physiotherapy, Branch Department of Aigion, Technological Educational Institute (TEI) of Western Greece, Psaron 6, 25100, Aigion, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Billis
authors.affiliation: Department of Physiotherapy, Branch Department of Aigion, Technological Educational Institute (TEI) of Western Greece, Psaron 6, 25100, Aigion, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Tsepis
authors.affiliation: Department of Physiotherapy, Branch Department of Aigion, Technological Educational Institute (TEI) of Western Greece, Psaron 6, 25100, Aigion, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Panoutsopoulou
authors.affiliation: Orthopedic Surgery Department, University Hospital of Patras, Rio, Greece.
authors.forename: J
authors.initials: J
authors.lastname: Gliatis
mesh_terms: D000058:Accidental Falls; D019645:Arthroplasty, Replacement, Knee; D005239:Fear; D006801:Humans; D015994:Incidence; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000601:surgery*; D011184:Postoperative Period; D004856:Postural Balance; D011434:Proprioception; D012306:Risk
keywords: Balance control; Falls; Falls risk; Systematic review; Total knee arthroplasty