Influence of Timing of Postoperative Weight-Bearing on Implant Failure Rate Among Older Patients With Intertrochanteric Hip Fractures: A Propensity Score Matching Cohort Study

Abstract

Introduction: The purpose of this study was to determine whether immediate weight-bearing as tolerated increased the risk of implant failure and decreased functional outcomes compared with restricted weight-bearing.Methods: From January 2010 to December 2018, 1,125 consecutive patients (≥65 years) with intertrochanteric fractures were identified. Of them, 130 patients were excluded, resulting in 995 patients in final cohort (563 receiving immediate weight-bearing and 432 receiving restricted weight-bearing). Propensity score (PS) matching yielded 403 patient pairs. Primary outcome was implant failure at 12 months. Secondary outcomes were implant failure at 3 months, functional outcomes at 12 months, and time to full weight-bearing.Results: Among 806 patients who were matched by PS, the mean age was 77.8 years (SD, 7.6), and 603 patients (74.8%) were women. After matching, there was no significant difference between immediate (10.0% [39/389]) and restricted (9.1%, [35/385]) weight-bearing for implant failure at 12 months (absolute risk difference, 0.93% [95% CI, −3.26 to 5.13%]; RR, 1.11 [95% CI, 0.69 to 1.80]; p = 0.66). Additionally, no significant difference was seen for implant failure at 3 months and functional outcomes at 12 months. Patients with immediate weight-bearing had shorter time to full weight-bearing (mean [SD], 87.6 days [7.5] vs. 121.3 days [11.0]; mean difference, −33.7 [95% CI, −35.0 to −32.3]; p < 0.001).Conclusions: Among older patients with intertrochanteric fractures, receipt of immediate weight-bearing as tolerated did not increase risks of implant failure or worsen functional outcomes compared with receipt of restricted weight-bearing. However, patients receiving immediate weight-bearing had a shorter time to full weight-bearing.

Effect of Postoperative Non-Weight-Bearing in Trochanteric Fracture of the Femur: A Retrospective Cohort Study Using Propensity Score Matching

“…[6][7][8][9] In previous reports, the disadvantages of WB restriction included delayed recovery of walking ability and rehabilitation after surgery. 14,20 Jia X, et al reported a significantly longer time to full WB application in the group with WB restriction. 14 Postoperative WB restriction is also associated with increased medical complications and mortality.…”

“…14,20 Jia X, et al reported a significantly longer time to full WB application in the group with WB restriction. 14 Postoperative WB restriction is also associated with increased medical complications and mortality. 13,19 In our study, there were no significant differences in medical complications, changes in walking ability, or length of hospital stay.…”

“… 13 However, few studies have reported the impact of postoperative WB restriction on surgical failures, such as cutout. 14 In addition, no study has assessed the impact of postoperative WB restriction on the prevention of surgical failures, such as cutout, considering the following risk factors for surgical failure: unstable fracture type, quality of intraoperative reduction, and TAD.…”

Gait dynamic stability evaluation in patients undergoing hip joint fractures – tools to measure rehabilitation effectiveness

“…During the rehabilitation period, weight-bearing by a fractured limb and transferring it to the healthy side are critical requirements to encounter [5,7]. A gait cycle (GC) presents a period from one heel contact to the next heel contact of the same limb [8].…”