Through retrospective Jeju-cohort study at 2005, we found low rates of detection of osteoporosis (20.1%) and medication for osteoporosis (15.5%) in those who experienced hip fracture. This study was to determine the orthopedic surgeons' awareness could increase the osteoporosis treatment rate after a hip fracture and the patient barriers to osteoporosis management. We prospectively followed 208 patients older than 50 yr who were enrolled for hip fractures during 2007 in Jeju-cohort. Thirty four fractures in men and 174 in women were treated at the eight hospitals. During the study period, orthopedic surgeons who worked at these hospitals attended two education sessions and were provided with posters and brochures. Patients were interviewed 6 months after discharge using an evaluation questionnaire regarding their perceptions of barriers to osteoporosis treatment. The patients were followed for a minimum of one year. Ninety-four patients (45.2%) underwent detection of osteoporosis by dual energy x-ray absorptiometry and 67 (32.2%) were prescribed medication for osteoporosis at the time of discharge. According to the questionnaire, the most common barrier to treatment for osteoporosis after a hip fracture was patients reluctance. The detection and medication rate for osteoporosis after hip fracture increased twofold after orthopedic surgeons had attended the intervention program. Nevertheless, the osteoporosis treatment rate remains inadequate.

BackgroundOsteoporosis treatment following hip fracture is well known to not enough. We previously performed intervention study for orthopaedic surgeon's education and reported twofold increase in osteoporosis detection and treatment rate observed between 2005 and 2007. This follow-up observational study was conducted to find out the rate in which a diagnostic workup and treatment for osteoporosis were done in patients with hip fracture.MethodsMedical records and radiographs in patients who were older than 50 years and diagnosed as having femoral neck or intertrochanteric fractures at 8 hospitals in Jeju island, South Korea from 2008 to 2011 were reviewed. The numbers of patients who were studied with bone densitometry and who were treated for osteoporosis after the diagnosis of hip fracture were analyzed.ResultsNine hundred forty five hip fractures (201 in 2008, 257 in 2009, 265 in 2010, and 304 in 2011) occurred in 191 men and 754 women during the study periods. The mean age of the patients was 79.7 years. The mean rate of osteoporosis detection using dual energy X-ray absorptiometry was 36.4% (344/945 hips) (ranged from 24.2% in 2009 to 40.5% in 2011). The mean initiation rate of osteoporosis treatment was 23.1% (218/945 hips) (ranged from 20% in 2009 to 29% in 2008).ConclusionsDetection and treatment rate of osteoporosis following hip fracture during follow-up periods was still not enough. Additional intervention studies are required to further improvement of osteoporosis treatment rates after hip fracture.

PurposeAlthough the incidence of a second hip fracture is relatively well described, mortality and morbidity after a second hip fracture are seldom evaluated. The purpose of this study was to determine the incidence, morbidity, and mid-term mortality of a second hip fracture and evaluate the cause of death after a second hip fracture.Materials and MethodsInformation on patients older than 50 years, who sustained a subsequent hip fracture, were obtained from the records of eight Jeju Island hospitals between 2002 and 2011 to calculate the incidence, morbidity, and mortality of hip fractures in this age group. All patients were followed a minimum of 2 years. A systemic search for death certificates at the National Statistical Office was conducted for patients who were lost to follow-up.ResultsOf 2,055 hip fractures (419 men and 1,636 women), 98 were second hip fractures (13 men and 85 women) during the study period. The mean ages of the patients at the time of the first and second fractures were 78.8 and 80.8 years, respectively. The incidence of a subsequent hip fracture among the first hip fracture was 4.8%. Mean mortality rates at 6 months, 1 year, 2 years, and 5 years were 10.5%, 15.2%, 23.5%, and 42.0% respectively. Cumulative mortality after the second hip fracture at the 5 years follow-up was 41.8%.ConclusionOur results demonstrate that a secondary fracture prevention program is necessary to prevent second hip fractures in elderly patients.

Background: This study aimed to identify the preoperative physical performance factors that predict gait speed and endurance 1 month after total knee arthroplasty (TKA). Methods: This prospective cohort study included all patients who underwent unilateral primary TKA in December 2014-2016. Before and at 1 month after TKA, gait variables, bilateral isometric knee extensor and flexor strength, and range of motion (ROM) (flexion and extension) of the operated knee were measured; further, a 6-minute walk test (6MWT), a Timed Up and Go (TUG) test, and a stair-climbing test (SCT) were conducted. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the EuroQoL 5-dimension (EQ-5D) questionnaire, and the visual analogue scale (VAS) of knee pain were also completed. Results: A total of 84 patients were included. Bivariate analyses showed that postoperative gait speed significantly and positively correlated with preoperative gait speed, gait cadence, ROM of knee flexion, and 6MWT, but significantly and negatively correlated with age and preoperative TUG test, SCT-descent, WOMAC-Function score, and VAS score. The postoperative 6MWT significantly and positively correlated with preoperative gait cadence and 6MWT, but significantly and negatively with preoperative body mass index (BMI), TUG test, SCT-ascent, and WOMAC-Function score. Linear regression analyses showed that age, preoperative ROM of knee flexion, and TUG test were independent predictors of postoperative gait speed, while preoperative BMI and 6MWT predicted postoperative 6MWT. Conclusion: These preoperative predictive factors will be useful in developing pre-and postoperative rehabilitation strategies aimed at improving gait function in the early stages after TKA.