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

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.