American Journal of Medical Quality 28(4) 335–338 © 2013 by the American College of Medical Quality Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860612469440 ajmq.sagepub.com Article Surgeons began performing total knee replacement sur- geries as early as 1968. Also known as a total knee arthro- plasty (TKA), this procedure has become one of the most successful procedures in medicine. Patients can receive a TKA for many reasons, including deterioration or injury of the bones or ligaments of the knee. Arthritis (specifi- cally osteoarthritis, rheumatoid arthritis, and posttrau- matic arthritis) is the top cause of chronic knee pain leading to total knee replacement surgery. The procedure involves replacing the surfaces of the knee joint with metal, polyethylene, or ceramic components. Surgeons first remove any damaged cartilage and the ends of the femur and tibia. Then they cement or fit the metal implants into both bones with a plastic spacer between them to recreate the joint. Often, the patella (kneecap) also is resurfaced. A TKA is recommended only after all other treatments, such as medicines or use of a walking support, have failed to relieve the pain or restore adequate function. 1 According to the American Academy of Orthopaedic Surgeons, approximately 581 000 primary TKA proce- dures were performed in the United States in 2009. Recent research suggests that by 2030, there will be close to 3.5 million TKAs performed annually. 2 Although female and white patients have the highest rates of knee replacement procedures, the burden of end-stage knee arthritis is experienced across all demographics. 3 Most patients experience severe pain immediately fol- lowing surgery, and pain control is vital to allow a patient earlier ambulation and a shorter recovery time. 4 One recent, important change in the TKA treatment algorithm has been a shift toward utilizing femoral nerve blockade (FNB) instead of epidural analgesia for postoperative pain control. Studies show that although the 2 methods provide equivalent pain scores, the incidence of postop- erative complications, including hypotension, urinary retention, and catheter-associated problems, is decreased in patients who receive FNB. 5,6 Furthermore, the rate of success in controlling postoperative pain is higher in patients who receive FNB, whereas the risk of long-term neurological complication is diminished. 6 Although there is conflicting evidence on whether single-shot or continu- ous FNB is the most efficacious delivery method, 4,7 much evidence suggests that FNB is the optimal method for pain control in the postoperative period after TKA. Despite its increased use, however, a notable problem associated with FNB is the increased rate of postopera- tive falls. The proposed mechanism underlying the increased propensity toward falling involves decreased 469440AJM XX X 10.1177/1062860612469440 American Journal of Medical QualityCui et al 1 University of Virginia School of Medicine, Charlottesville, VA The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors received no financial support for the research, authorship, and/or publication of this article. Corresponding Author: Quanjun Cui, MD, Department of Orthopaedic Surgery, Box 800159, University of Virginia Health Sciences Center, Charlottesville, VA 22908 Email: qc4q@virginia.edu Reducing Costly Falls of Total Knee Replacement Patients Quanjun Cui, MD, 1 Laura H. Schapiro, MPH, 1 Matthew C. Kinney, MD, 1 Peter Simon, PT, 1 Andrew Poole, PT, 1 and Wendy M. Novicoff, PhD 1 Abstract The objective of this study was to determine whether the use of a knee immobilizer brace reduces patient falls associated with the recent use of femoral nerve blocks for pain control after total knee arthroplasty (TKA). The authors conducted a retrospective study to investigate fall rates before and after the introduction of an immobilizer brace.The demographics of patients and total cost of care were examined. Of the 600 TKA patients who did not receive a knee immobilizer, 22 (3.7%) experienced a fall. In contrast, of the 502 patients who received knee immobilizers, only 8 patients (1.6%) fell. This difference achieves statistical significance (P = .04). Given the considerable costs associated with hospital falls and the significant reduction of these falls related to knee immobilizer use shown in this study, the authors recommend that knee immobilizers be given to TKA patients as standard practice. Keywords falls, total knee arthroplasty, knee immobilizer, quality improvement, cost-effective