# Preoperative perturbation training to prevent falls after total knee arthroplasty

> **NIH NIH R01** · UNIVERSITY OF ILLINOIS AT CHICAGO · 2023 · $569,349

## Abstract

Falls are the most common cause for injury-related hospitalization in older adults and account for over $50
billion per year in medical costs. For the ~27% of US adults with symptomatic osteoarthritis (OA) the odds of
falling are up to 54% higher than for people without OA. The high incidence of falls associated with OA remains
high after total knee arthroplasty (TKA). The incidence of falls during the first year after TKA is up to 51.8%.
With over 750,000 TKAs performed annually, the scope of the problem is large. Despite several calls in the
literature for new methods to decrease fall rate after TKA, there are, to our knowledge, no such interventions
specifically targeting this group. Our recent work, however, demonstrates the promise of perturbation training
in knee OA. We have established that limiting trunk angle and angular velocity during the initial recovery step
after a disturbance, such as a trip, is a critical factor in avoiding a fall. This motor skill can be improved through
task-specific perturbation training. In our pilot study, trip-specific perturbation training effectively improved trunk
kinematics during the initial recovery step after a trip-simulating perturbation in women with moderately
symptomatic OA. Further, we have shown that trip-specific perturbation-training reduces fall-rates in the
community in healthy older women. Building on this past success, our long-term goal is to reduce the incidence
of preventable gait-related falls by older adults with joint replacements. The objective of this application is to
establish that preoperative task-specific training of stepping responses to sagittal and frontal plane
disturbances reduces the risk of postoperative falls in people undergoing TKA. Our central hypothesis is that
individualized preoperative sagittal and frontal plane perturbation training will significantly reduce postoperative
fall rates in people scheduled for TKA by improving trunk kinematics during the initial recovery step. To test this
hypothesis, we will evaluate preoperative TKA patients, randomized into either a perturbation-training group or
a conventional fall-prevention education group. We will assess our central hypothesis through two aims. Aim 1:
Demonstrate the extent to which perturbation training focused on forward and laterally directed stepping
responses improves recovery step trunk mechanics in preoperative TKA patients. Aim 2: Demonstrate the
effectiveness of forward and laterally directed perturbation training in reducing incidence of preventable gait-
related falls for one year after TKA. With extensive collective expertise in OA and arthroplasty gait mechanics,
aging, falls, and fall-prevention, including clinical trial experience, we are well poised to accomplish these aims.
Further, through our innovative prehabilitation approach, we will, for the first time, address both trip-specific
and laterally directed falls in this patient population. In addition, this study will advance our mechanis...

## Key facts

- **NIH application ID:** 10690039
- **Project number:** 5R01AG075098-02
- **Recipient organization:** UNIVERSITY OF ILLINOIS AT CHICAGO
- **Principal Investigator:** Kharma Charisse Foucher
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $569,349
- **Award type:** 5
- **Project period:** 2022-09-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10690039

## Citation

> US National Institutes of Health, RePORTER application 10690039, Preoperative perturbation training to prevent falls after total knee arthroplasty (5R01AG075098-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10690039. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*