Impact of Total Knee Arthroplasty on Dynamic Fall Response

Falls are the leading cause of fatal and non-fatal injuries in the older adult population with more than 27,000 fall related deaths reported every year[1]. Adults suffering from lower extremity arthritis have more than twice the likelihood of experiencing multiple falls resulting in increased fall-related injuries compared to healthy adults. People with lower extremity end-stage osteoarthritis(KOA), experience a number of fall risk factors such as knee instability, poor mobility, and knee pain/stiffness. At end-stage knee OA, the space between the bones in the joint of the knee is significantly reduced, resulting in bone to bone frictional wearing causing bone deformation. In addition, an impaired stepping response during a postural perturbation is seen in people with OA related knee instability. The most common treatment for end-stage knee osteoarthritis is a surgical procedure called, total knee replacement (TKR). It is known that TKR significantly reduces pain, knee stiffness, and restores musculoskeletal functions such as range of motion. Despite studies concluding that knee OA increases fall-risk, it remains unknown if standard treatments, such as TKR, can effectively decrease fall-risk. Analyzing the compensatory step response during a fall is a significant indicator of whether a fall or a recovery will occur in the event of a postural disturbance and is key to determining fall risk among people. Studies have shown reduced trunk stability and step length, as well as increased trunk velocities, correspond to an impaired compensatory step. This study looks at these populations to determine whether TKR significantly enhances compensatory stepping response by analyzing trunk velocities and flexions among other kinematic/kinetic variable analysis during treadmill induced perturbations and clinical assessments.