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Falls and Fractures After Total Hip Arthroplasty: Associations with Preoperative
Physical Function and Postoperative Balance Confidence, with Insights from
Cluster Analysis
#MMPMID41185849
Konishi T
; Hamai S
; Fujita T
; Hara D
; Kawahara S
; Motomura G
; Utsunomiya T
; Yamate S
; Nakao Y
; Inoue T
; Uehara W
; Nakashima Y
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41185849
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BACKGROUND: Falls and fractures are major concerns after total hip arthroplasty
(THA), although underrecognized. Their associations with preoperative physical
function and balance confidence are not well understood. METHODS: This
retrospective cohort study included 438 hips from 401 patients who underwent
primary THA for osteoarthritis and completed a mailed survey more than 3 years
postoperatively (mean follow-up, 6.9 years). Preoperative assessments included
standardized measurements of hip range of motion, knee and hip strength, and gait
speed. The survey assessed the number of falls in the past year, history of
postoperative fractures, and the Activities-specific Balance Confidence Scale
(ABCs), which measures confidence in balance. Receiver operating characteristic
(ROC) analyses evaluated the ability of ABCs for identifying patients with falls
and postoperative fractures. Unsupervised Gower-based clustering using fall
history and ABCs was performed to classify patient subgroups. Multivariable
Poisson, logistic regression, and linear models identified risk factors for
falls, fractures, and low ABCs. RESULTS: Falls were reported in 29.5% of hips,
fractures in 16.4%-of which 0.7% were periprosthetic-and mean ABCs was 83.4%.
ABCs showed a significant negative correlation with fall frequency. ROC analysis
identified a cutoff of 90.3% for falls (area under the curve [AUC] = 0.703, P <
0.001), but ABCs showed unsatisfactory discrimination for fractures (AUC = 0.599,
P = 0.071). Cluster analysis revealed that patients with a fall history despite
high postoperative ABCs had the highest fracture prevalence (29%). Greater
preoperative knee extensor strength was predictive of fewer falls and higher
ABCs, while faster preoperative gait speed and absence of recent falls were
predictive of lower fracture risk. CONCLUSIONS: ABCs was useful for identifying
fall risk but insufficient for predicting postoperative fractures. Cluster
analysis revealed that patients with high postoperative balance confidence
despite fall history were at the greatest risk of postoperative fractures.
Preoperative knee extensor strength and gait speed were important predictors of
postoperative falls and fractures. Evaluating physical function and promoting
fall-prevention awareness-particularly among confident yet at-risk
individuals-may enhance postoperative safety. LEVEL OF EVIDENCE: Level III,
retrospective cohort study. See Instructions for Authors for a complete
description of levels of evidence. CLINICAL RELEVANCE: Falls and fractures after
THA remain underrecognized but clinically important complications. Identifying
predictive preoperative factors such as knee extensor strength and gait speed,
along with discrepancies between postoperative balance confidence and fall
history, provides actionable insights for risk stratification and fall-prevention
strategies in clinical practice.
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