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GPs urged to treat knee buckling in patients with osteoarthritis to prevent future falls



GPs should treat knee buckling in older people with osteoarthritis as a ‘priority’ and should use targeted exercises to prevent future falls and provide peace of mind, researchers claim.

The team from the University of California-San Francisco examined the association of knee-buckling with the risk of falling in adults aged between 55 and 84 with – or at high risk of – osteoarthritis.

They found that those who experienced knee buckling were two to three times more likely to have fallen over within the past year.

In total, about one in five of the study participants fell over as a result of their knee buckling, and these people also had a higher risk of recurrent falls, injury or poor balance confidence two years later.

People whose knees buckled were also more likely to have a ‘fear of falling’ and, as a result, refrained from activities that could have caused buckling, which researchers believe may contribute to further deconditioning, exacerbating the problem.

The results, published in Arthritis Care & Research suggest that knee buckling is an independent risk factor for falls in people with knee pain or osteoarthritis and the team urge GPs to use interventions that directly treat knee instability in order to prevent future falls.

Concluding in the study, the researchers write: ‘Persons who fall when a knee gives way have an especially high risk of future recurrent falls, injurious falls, fear of falling and poor balance confidence. Finding effective treatments for knee instability should be a priority and may help prevent knee buckling and falls and their adverse consequences in older persons with knee pain.’

The study is one of the first pieces of research to investigate knee buckling as a risk factor for falling in people with osteoarthritis and experts believe it has important implications for GPs.

Dr Tom Margham, a London-based GP and former spokesperson for Arthritis Research UK, said: ‘Taking steps to manage instability is a promising way of improving pain and symptoms [in patients with osteoarthritis]. Bracing is one method to do this but exercises to improve muscle strength around the knee are important too and need no specialist equipment.

He continued: ‘GPs should be recommending these exercises to all patients with osteoarthritis as a core treatment.’

Dr Michael Nevitt, from the University of California-San Francisco and author of the study said: ‘Falls, injury from falls and poor balance confidence are extremely common and debilitating problems in older people. The present study has demonstrated for the first time that knee instability and knee buckling are important causes of these problems in the very large segment of the older population suffering from knee pain.’

He added: ‘Fortunately, it may be possible to treat knee instability and prevent knee buckling with targeted exercises.’