3 fall-related risks after orthopedic surgery

Orthopedic Knee Surgery Patient with Doctor
After surgery, navigating your path to recovery can be a minefield. As you work with your care team and family to plan your rehabilitation strategy, here are three post-operative risks to be aware of, along with potential options to overcome these risks:

1) Increased risk of neuropathy: Depending upon what type of surgery you undergo, the procedure may increase the risk of peripheral neuropathy. Simply defined, neuropathy is a condition that results from damage to nerves in areas such as the limbs, hands, and feet.   Symptoms of neuropathy may include weakness, numbness, or pain in these areas [1]. A study of 139 postsurgical orthopedic rehab patients found that 45% complained of probable or highly probable neuropathic pain [2].

If untreated, neuropathy can greatly increase your risk of falls.

What you can do to reduce risk: Diagnosing neuropathy is difficult because the symptoms can vary widely. If you notice symptoms of numbness, weakness, or pain in your limbs, hands, or feet, consult your orthopedic surgeon and primary care physician immediately. Your care team may recommend a comprehensive neurological exam to identify causes and extent of damage [3]. If diagnosed early, a combination of pain medication, rehabilitation, and physician-supervised dietary and exercise programs may help reduce symptoms. When these symptoms are present, it is wise to have a medical bracelet to alert emergency services and family that a fall has occurred. 

2)      Complications from painkillers: Thinking you need prescription painkillers/opioids such as Vicodin or Oxycodone? Just remember, potential adverse side effects include sedation, nausea, vomiting, and disorientation [4], which can put you at greater risk of falls. Furthermore, painkillers can be addictive and overdoses fatal.

To learn more about drug overdose statistics in the USA, visit RehabAid's Interactive Map

What you can do to reduce risk: Consult with your care team regarding different pain medication options. Based upon your sensitivities and symptoms, your physician may prescribe non-opioid analgesics such as aspirin, ibuprofen or paracetamol (e.g. Tylenol) in combination with opioids to achieve desired pain relief and minimal adverse effects. Results from 51 studies with over 5,000 participants showed a single oral dose of paracetamol achieved substantive relief over four to six hours for acute pain [5].   In cases where opioids have been prescribed, studies have indicated that a lower dose of opioids in combination with non-opioid analgesics may be an effective course for minimizing side effects [6].

3)      Post-operative decline in mobility: One of the great risks of surgery is the adverse impact on mobility and physical activity while in recovery. After surgery, there is a tendency to remain bedridden during inpatient stays, transitional care stays, and even at home or in long-term care [7]. Extended bed rest and sedentary behavior can greatly increase both short- and long-term risk factors, especially among older adults.  Dr. Cynthia Brown from the University of Alabama Birmingham School of Medicine has conducted extensive research correlating extended bed rest to muscle and bone deconditioning, which tends to reduce functional mobility and increase short-term fall risk [7][8][9].   Over the long-term, the resulting decline in mobility can greatly increase risk of cardiovascular disease, diabetes, and other chronic conditions.

What you can do to reduce risk:  Depending upon your condition after surgery, your orthopedic doctor and rehab team will likely put weight-bearing restrictions on you to prevent re-injury and ensure proper healing of bone and muscle tissue [10][11]. At the same time, they may recommend some form of daily/weekly weight-bearing exercise to prevent overall muscle deconditioning. Recommendations may include no weight bearing, touch-down weight bearing (where foot/toes touch floor but don’t bear weight on the affected leg), partial weight-bearing, or full weight-bearing [12]. Weight-bearing exercises can include, but are not limited to, activities such as jogging, walking, stair-climbing, aerobics, tai chi, yoga, squats, or lunges. Given that the short-term need to heal an affected limb/foot may often conflict with the long-term need to stay mobile and bear weight, it is critical that you receive guidance from a strong rehab team that can help you navigate through all phases of recovery.  Consider doing this research on rehabilitation options prior to surgery, as it will pay dividends later.

Inasmuch as orthopedic surgery aims to extend range of motion and quality of life [13], patient adherence to prescribed rehabilitation programs, medication, exercise, and diet is critical to post-operative recovery and long-term care. You should coordinate closely with your hospital discharge planner and care team, as well as your family, to ensure you receive the best rehabilitation and post-operative support possible.