Reducing costly falls after total knee arthroplasty.

AIM: To investigate whether adductor canal nerve block (ACB) reduces patient falls when compared to femoral nerve block (FNB) after total knee arthroplasty (TKA).

METHODS: We conducted an institutional review of all-cause falls after TKA from January 2013 to August 2016 using a quality improvement database. Our inclusion criteria were patients with diagnosis of primary knee osteoarthritis who underwent primary unilateral TKA with either a FNB or an ACB and sustained a fall during their hospitalization. We excluded patients who had revision TKA and extensor mechanism reconstruction. We also excluded patients with a history of post-traumatic arthritis, prior history of lower extremity fracture, history of neurological disease, or cerebrovascular disease.

RESULTS: A total of 834 patients had TKA with femoral nerve block and knee immobilizer (FNB + KI). Of those patients, 11 (1.3%) experienced a fall during their hospital stay. In contrast, 791 patients had TKA with ACB. Of those patients, only one (0.13%) patient fall was recorded within this group. We used the Fisher's exact test to compare the differences between the two groups. The difference between the two groups achieves statistical significance ( P = 0.006). We also found that 11 out of the 12 patients that fell had a right TKA procedure while one patient had a left TKA procedure. Nine out of twelve patients that fell were female, while only three patients were male.

CONCLUSION: Given the reduction in the number of falls with ACB, it is recommended that ACB be considered the preferred analgesia for patients undergoing a TKA procedure.