Knee Replacement: Steps After a Fall, Risks, and Prevention

What to do if you fall after knee replacement?

If you fall after a knee replacement, remain calm and immediately assess your condition for pain, deformity, or inability to move. If you suspect any serious injury, do not attempt to get up; instead, call for emergency help. Even if you feel fine, it is crucial to seek prompt medical evaluation from your orthopedic surgeon to rule out complications to the prosthetic joint or surrounding bone.

Understanding the Risk of Falls Post-Knee Replacement

Falling after a total knee replacement (TKR) is a significant concern due to the potential for serious complications. While the prosthetic knee joint is designed for durability, a fall can exert forces that exceed its tolerance or the strength of the surrounding bone.

• Why Falls Are Concerning:

  • Periprosthetic Fracture: A fracture around the implant is a severe complication that often requires complex revision surgery.
  • Implant Loosening or Dislocation: Although less common with knee replacements than hip replacements, severe trauma can potentially loosen components or, in rare cases, cause dislocation.
  • Soft Tissue Injury: Ligament sprains, muscle strains, or contusions can occur, prolonging recovery.
  • Other Injuries: Falls can also lead to fractures in other areas (e.g., hip, wrist, spine), especially in individuals with osteoporosis.
  • Fear of Falling: A fall can significantly impact confidence and lead to reduced physical activity, hindering rehabilitation progress.

• Common Causes of Falls Post-TKR:

  • Residual Weakness: Quadriceps and gluteal weakness are common post-surgery.
  • Balance Deficits: Impaired proprioception (the body's sense of position in space) and balance issues.
  • Pain and Swelling: Can affect gait and stability.
  • Medication Side Effects: Dizziness or drowsiness from pain medications.
  • Environmental Hazards: Uneven surfaces, throw rugs, poor lighting, stairs.
  • Rushing Activities: Attempting movements too quickly or without adequate support.

Immediate Steps After a Fall: "STOP, ASSESS, CALL"

Your immediate reaction after a fall is critical. Prioritize safety and avoid actions that could worsen an injury.

1. STOP and Stay Calm: Do not panic. Take a few deep breaths. Rushing can lead to further injury.
2. ASSESS Your Body:
   • Check for Pain: Is there new or severe pain, particularly in your operated knee, hip, or back?
   • Check for Deformity: Look for any unnatural angles, swelling, or bruising around your knee, leg, or other joints.
   • Attempt Gentle Movement: Can you gently move your toes or fingers? Can you wiggle your operated leg slightly without severe pain?
   • Do NOT attempt to put weight on the operated leg if you feel severe pain, hear a "pop," or suspect a fracture.
3. CALL for Help:
   • If you suspect a serious injury (severe pain, deformity, inability to move the leg, head injury): Immediately call emergency services (e.g., 911 or your local equivalent).
   • If you are unsure or feel minor pain: Call a family member, friend, or neighbor who can assist you and help assess the situation. Have a phone readily accessible.

How to Get Up Safely (If You Are Sure No Serious Injury)

Only attempt to get up if you are absolutely certain you have not sustained a serious injury and feel capable. If there is any doubt, wait for help.

1. Roll Onto Your Side: Slowly roll onto your side, preferably towards your non-operated leg if possible, or whichever side feels safest.
2. Crawl to a Sturdy Support: If able, crawl on your hands and knees to a sturdy piece of furniture, such as a strong chair, couch, or bed. Avoid using flimsy objects.
3. Position Yourself: Kneel on both knees (or just your non-operated knee if the operated knee is painful) facing the furniture, placing your hands firmly on the seat.
4. Lift One Leg: Bring your stronger, non-operated foot forward, placing it flat on the floor.
5. Push Up: Using your arms on the furniture and your non-operated leg, slowly push yourself up into a standing position. Keep your operated leg slightly behind you, allowing it to take minimal weight initially.
6. Sit Down Immediately: Once standing, pivot slowly and sit down on the furniture to regain your composure and further assess yourself.
7. Take Your Time: Do not rush any part of this process. Listen to your body.

Post-Fall Medical Evaluation is Crucial

Regardless of how you feel after a fall, it is imperative to contact your orthopedic surgeon or seek medical attention promptly. Even a seemingly minor fall can cause subtle damage that may not be immediately apparent.

• Why Immediate Evaluation?
  • Hidden Injuries: Fractures, even small ones, or implant loosening may not cause immediate severe pain but can worsen over time.
  • Implant Integrity: A fall can compromise the stability or alignment of your prosthetic joint.
  • Baseline Assessment: Your doctor will compare your post-fall condition to your surgical baseline.
• What to Expect During Evaluation:
  • Physical Examination: Assessment of your knee, hip, and other joints, checking for swelling, tenderness, range of motion, and stability.
  • Imaging Studies: X-rays are almost always performed to check for periprosthetic fractures or implant displacement. In some cases, a CT scan or MRI may be necessary for a more detailed view of the bone and soft tissues.
  • Discussion of Symptoms: Be honest and thorough about how you fell, what you felt, and any symptoms you are experiencing.

Preventing Future Falls: A Proactive Approach

Fall prevention is a cornerstone of long-term success after knee replacement. A multi-faceted approach addressing physical capabilities, environmental factors, and lifestyle choices is essential.

• Physical Therapy & Exercise:
  • Continue your prescribed exercise program focusing on strengthening the quadriceps, hamstrings, glutes, and core muscles.
  • Balance Training: Incorporate specific exercises to improve proprioception and static/dynamic balance. Your physical therapist can guide you on appropriate exercises.
  • Gait Training: Work on improving your walking pattern, stride length, and overall stability.
• Home Safety Modifications:
  • Remove Trip Hazards: Eliminate throw rugs, loose cords, and clutter from walkways.
  • Adequate Lighting: Ensure all areas are well-lit, especially stairs and hallways. Use nightlights.
  • Grab Bars: Install grab bars in the bathroom (shower, toilet) and by stairways.
  • Non-Slip Surfaces: Use non-slip mats in the shower/bathtub.
  • Clear Pathways: Keep furniture arranged to allow clear walking paths.
• Medication Review:
  • Regularly review all medications (prescription and over-the-counter) with your doctor or pharmacist.
  • Discuss potential side effects like dizziness, drowsiness, or lightheadedness, which can increase fall risk.
• Proper Footwear:
  • Wear supportive, well-fitting shoes with non-slip soles. Avoid loose slippers, high heels, or walking in socks.
• Assistive Devices:
  • Continue using your walker, cane, or crutches for as long as your surgeon or physical therapist recommends. Do not discontinue them prematurely.
• Lifestyle Factors:
  • Stay Hydrated and Nourished: Dehydration and poor nutrition can contribute to weakness and dizziness.
  • Vision Checks: Ensure your vision is regularly checked and your eyewear prescription is up-to-date.
• Mindful Movement:
  • Avoid rushing when walking, standing, or turning.
  • Use handrails on stairs.
  • Be extra cautious on wet or uneven surfaces.

When to Seek Immediate Emergency Care

Call 911 or your local emergency number if, after a fall, you experience any of the following:

• Inability to bear any weight on your operated leg.
• New, severe, or escalating pain in your knee, hip, or back.
• Obvious deformity, significant swelling, or bruising around your knee or leg.
• Loss of consciousness, dizziness, or confusion.
• Signs of a head injury (e.g., headache, nausea, vision changes).
• Significant bleeding or an open wound.

The Role of Your Healthcare Team

Your orthopedic surgeon, physical therapist, occupational therapist, and primary care physician all play vital roles in your recovery and fall prevention. Communicate openly with them about any falls, near-falls, or concerns you have about your balance or mobility. Their combined expertise is crucial for ensuring the long-term success and safety of your knee replacement.