Two of my friends and their colleagues point attention to the fact that falls are the most common cause of injury to older patients, resulting in >3 million emergency room visits per year and 290,000 hip fractures annually in the United States.
They call on orthopaedic surgeons to become involved in the assessment of fall risk and providing prevention strategies for their patients. Many (up to 40%) patients awaiting joint arthroplasty sustain a fall.
Importantly, 20% to 40% of patients having arthroplasty sustain a fall postoperatively.
Outpatient falls occur in 10% of patients after shoulder replacement. See: Inpatient falls after shoulder arthroplasty Patient characteristics associated with the occurrence of falls after arthroplasty included older age and lower household income. In decreasing order of magnitude, the comorbidities associated with falls were fluid/electrolyte disorder, opioid use disorder, malnutrition/weight loss, chronic anemia, visual impairment, nonopioid drug use disorder, congestive heart failure, and hearing impairment. The rate of in-hospital falls after shoulder arthroplasty is increasing despite shorter stays. Many of the identified factors associated with inpatient falls after shoulder arthroplasty are modifiable, either by better preoperative planning and care coordination, by optimized medical management, or by improved patient education and engagement.
Comment: It is always worthwhile to ask patients considering shoulder surgery about a past history of dizziness, balance problems or falls. Such questions not infrequently reveal a history of cardiac syncope, spine disease, neurpathy or seizures. Patients having shoulder arthroplasty may also have lower extremity arthritis contributing to awkwardness or weakness. Psychoactive medications and cardiac medications increase fall risk.
Patients and family members are encouraged to do a preoperative safety check, being on the lookout for loose rugs, slippery floors, cords and cables in walkways, pets, dishwasher doors, poor lighting, stairs without railings, uncorrected vision, and sloppy shoes.
Shoulder surgery can render patients more vulnerable to falls immediately after surgery than they were beforehand. Sling use can compromise balance as can dehydration and pain medications. For these reasons it is important to have a friend or family member be close by until the patient is securely back on their feet.
An ounce of prevention is worth a pound of cure.
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