Preoperative Factors Associated With Falls Following Total Hip Arthroplasty in Older Adults

Falls are common after total hip arthroplasty (THA) and can cause serious complications. Understanding preoperative factors linked to falls post-THA can inform discharge planning and management to lower fall risk. We aimed to identify preoperative factors associated with falls occurring within one year following THA in older adults.

We performed a retrospective cohort study using records within a large hospital system. Adults aged ≥65 years with a recorded THA between March 2012 and March 2022 were included. The primary outcome was a fall occurrence (yes vs no) within one year post-THA. A fall was identified through International Classification of Diseases, Ninth/Tenth Revision codes, documentation for fall-related emergency room visit(s), or mention of a fall in the medical record. Purposeful selection of variables in logistic regression models identified preoperative factors associated with a fall.

Among 4,501 patients (age 72.7 ± 6.0 years), 683 (15.2%) experienced at least one fall within one year post-THA. The strongest risk factors were a fall within one year pre-THA (odds ratio [OR] = 2.67, 95% confidence interval [CI] = 2.22-3.22) and depression (OR = 1.95, 95% CI = 1.62-2.35). Other factors included neurologic conditions, insomnia, revision or conversion hip arthroplasty, knee pain, lumbar conditions, body mass index (BMI) <20 kg/m², and older age. A BMI of 25 to 29.9 was protective against falls.

This longitudinal cohort study identified multiple independent factors associated with fall occurrences within one year post-THA. Findings highlight the opportunity to address modifiable factors and provide individuals with tailored discharge planning and management strategies (eg, fall prevention programs) to reduce fall risk.