Knee replacement surgery also known as Knee Arthroplasty is a surgical technique to resurface an impaired knee by Osteoarthritis which aims at avoiding pain and restoring function 8. As alleviating pain, restoration of mobility and neuromuscular control are the most important factors for return to function after TKR. Among all, the most significant factor in improving balance, joint
stability, coordination, and to minimize risk of injury is proprioception 20. After TKR, patients often reported loss of balance and postural sway during walking. Asymmetrical patterns of gait, reduced posture control and increased forward sway of trunk increase the risk of fall in the individual, particularly in the early phase of post operative recovery21. Alongside the course of joint articulating surfaces deterioration in OA and during replacement surgery, the knee loses a number of joint mechanoreceptors that is proprioceptors, as the integrity of ligaments, menisci is disturbed. So, after the surgery sensory receptors are unable to detect the knee postural control which is particularly regulated by joint oscillation mechanism22. Surgery also causes decreased residual function and diminished muscle strength along with the compensatory mechanisms which in turn leads to defective sensory and motorized joint functions. These aspects predispose individual to a greater risk of fall as evidenced by the high frequency of fall among older adults23. The most essential and critical characteristics of arthritis are found to be postural control and knee stability, specifically after arthroplasty24. The general failure rate of TKR was decreased to a greater amount as the surgical procedure advances, the task of maintaining balance is an important factor to be considered.
The result of the systematic review shows that early recovery phase after surgery is poorly encountered due to decreased mobility and inadequate extra capsular proprioceptive strength, which in turn leads to greater fall risks.
Moreover, it was subjectively reported that fall episodes was observed more after TKR then prior to surgery. This analysis from systematic review highlighted different aspects including patients’ falls which include: age factors, visual disturbances, heart related issues, diabetes and impaired function including muscular weakness, decreased range, and impaired gait.
Less evidences were present that are concerned with the limited effects of clinical scales, less range before surgery and minimal differences between falling and non-falling subjects. Regardless of increased functionality and pain improvement after arthroplasty, fall risk and its terrific consequences such as prosthetic related fractures and failed implant continue to be the major issues. Falls can result due to a variety of factors and the adequate strategy to decrease and eliminate this risk is yet not established. This is mainly due to the diminished number of proper scales and tools to identify the individuals categorized in fall risk25.
Past evidences focuses on strategies for alleviating pain and muscle strengthening26 in order to return to function and ignored the evaluation of association between falls and impaired proprioception.
The study has certain limitations. Meta-analysis was not conducted for the risk factors and ignoring the GRADE approach. The studies included utilized patient reported outcomes or medical records which can be a major source of recall bias. Thus, some risk factors might have been missed. Future researches are required to determine the risk factors and intervention strategies for the particular subjects. Further evidences also need to be established for the pre and post-surgical management of elderly arthritic population undergoing arthroplasty, to decrease the fall risks and its tremendous negative consequences.