Walking ability before and after a hip fracture in elderly predict greater long-term survivorship

Iosifidis, Michael; Iliopoulos, Efthymios; Panagiotou, Anastasios; Apostolidis, Konstantinos; Traios, S.; Giantsis, Georgios

doi:10.1016/j.jos.2015.09.009

Cited by 32 publications

(25 citation statements)

References 29 publications

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“…However, it does not indicate that obesity correlates with high activity, because patients included had a BMI < 30. Besides this, preoperative serum albumin levels were determined as an independent risk factor for diminished postoperative activity and delayed recovery, correlating with the findings that malnutrition is a predictor for mortality a er hip fractures [42] and preoperative mobility for long term survival [4,43]. Considering this importance of physical activity in the recuperation process, it appears essential to recognize deficits as early as possible.…”

Section: Parameters Influencing Activitymentioning

confidence: 86%

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Objectively Measured Physical Activity and Its Association with Functional Independence, Quality of Life and In-Hospital Course of Recovery in Elderly Patients with Proximal Femur Fractures: A Prospective Cohort Study

Marsault

Ryg

Madsen

et al. 2020

Rehabilitation Research and Practice

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Background. Physical activity in elderly patients is crucial for recovery from proximal femoral fractures. Considering the limited possibilities for objective measurement, we aimed to evaluate the use of an accelerometer in this population to determine activity’s association with functional independence, quality of life, and course of recovery. Methods. 52 patients undergoing operative treatment for proximal femur fractures (81.3 ± 7.5 years) were included in a prospective cohort study. 12 patients with fall but without fracture of the lower extremities (80.8 ± 9.5 years) served as control. An Axivity AX3 tracker continuously recorded signal vector magnitudes during the hospital stay. Additionally, 2 ± 1 and 8 ± 3 days (time point 1 and 2) after operation EuroQol-5D and Barthel-20 indices were evaluated. Results. Physical activity increased in all patients with time. Multiple regression analyses revealed that a high Barthel-20 before fracture, a low age, a high body mass index, high albumin, and low C-reactive protein levels were independent predictors for high physical activity at time point 1 (p<0.05). Physical activity correlated significantly with EuroQol-5D and Barthel-20 at time point 1 and 2 (p<0.02). Furthermore, physical activity at time point 1 predicted EuroQol-5D, physical activity, and Barthel-20 at time point 2 (p<0.01). A multiple regression demonstrated equal physical activity in patients with or without a hip fracture. Conclusions. Accelerometer signals correlate with postoperative physical activity, Barthel-20 and quality of life in elderly patients. Physical activity is thereby positively influenced by a high prefall functional independence and a good nutrition status. A timely and adequate operation provided, there is no difference between patients with or without a fracture. This trial is registered with DRKS 00011934 on 10th April 2017.

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Section: Parameters Influencing Activitymentioning

confidence: 86%

“…An influenceable key factor for a successful reintegration into normal life is the recovery of mobility. Although most hip fracture patients do not regain their habitual physical activity (PA) level [3], an early start of rehabilitation and increased postoperative activity are associated with improved outcomes [4].…”

Section: Introductionmentioning

confidence: 99%

Objectively Measured Physical Activity and Its Association with Functional Independence, Quality of Life and In-Hospital Course of Recovery in Elderly Patients with Proximal Femur Fractures: A Prospective Cohort Study

Marsault

Ryg

Madsen

et al. 2020

Rehabilitation Research and Practice

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“…Salpakoski 26 point out that there are more patients with difficulty walking after internal fixation than hemiarthroplasty or total hip arthroplasty. Early postoperative walking ability is a significant predictor of postoperative survival in elderly patients with hip fractures 27 . Partial weight-bearing can be carried out earlier in the hemiarthroplasty group than in the internal fixation group.…”

Section: Discussionmentioning

confidence: 99%

Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta‐Analysis

Liu

et al. 2020

Orthopaedic Surgery

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Objective To evaluate the clinical efficacy of internal fixation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. Methods A search was conducted in PubMed, Web of Science, Embase, and Cochrane Library databases up to April 2020. The present study compared internal fixation and hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. RevMan5.3 software provided by the International Cochrane Group was used for the meta‐analysis. To compare the differences in the operation time, intraoperative bleeding, length of hospital stay, superficial infection, Harris hip score, mortality within 1 year, mortality within 2 years, reoperation, incidence of deep venous thrombosis (DVT), partial weight‐bearing time, non‐union, and implant‐related complications between an internal fixation group and an hemiarthroplasty group. Results A total of 1300 patients were included in nine studies. The results showed that the operation time (MD = −18.09, 95% CI: −27.85–−8.34, P = 0.0003), intraoperative bleeding (MD = −195.31, 95% CI: −244.8–−147.74, P < 0.0001), implant‐related complications (MD = 3.83, 95% CI: 1.74–8.45, P = 0.0008), and partial weight‐bearing time (MD = 17.21, 95% CI: 1.63–32.79, P = 0.03) have statistical significance. However, there is not statistical significance for the Harris hip joint function scale (HHS) (MD = 5.60, 95% CI: −1.13–12.33, P = 0.10), DVT (MD = 1.02, 95% CI: 0.45–2.27, P = 0.97), length of hospital stay (MD = ‐1.08, 95% CI: −2.82–0.66, P = 0.22), superficial Infection (OR = 0.92, 95% CI: 0.43–1.98, P = 0.89), mortality within 1 year (OR = 0.95, 95% CI: 0.61–1.48, P = 0.81), mortality within 2 years (OR = 0.93, 95% CI: 0.61–1.43, P = 0.75), reoperation (MD = 1.80, 95% CI: 0.64–5.04, P = 0.26), and non‐union (OR = 1.20, 95% CI: 0.48–3.03, P = 0.70). The result of the subgroup analysis showed no significant differences between the less than 2 years follow‐up and the 2 years or more follow‐up group. The only difference was for the Harris hip score: the internal fixation group was superior to the hemiarthroplasty group in the less than 2 years subgroup analysis, while there was no difference between the internal fixation group hemiarthroplasty group in the 2 years or more subgroup analysis. Conclusion Compared with the internal fixation group, those in the hemiarthroplasty group could carry out weight‐bearing training early and implant‐related complications were reduced, but it requires longer operation time and there is greater intraoperative blood loss. There is no difference in mortality, the incidence of DVT, non‐union, HHS, reoperation, length of hospital stay, and superficial infection. Hemiarthroplasty may be a better choice for unstable intertrochanteric fractures in the elderly.

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“…Pre-fracture mobility reflects the general condition of patient’s health and related to the outcomes of surgery. Previous studies reported that walking ability before hip fracture could predict greater long-term survival [ 12 ] and affect the short-term and long-term mortality in hip fracture patients [ 20 ]. Similar findings were observed in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to the annual 4% increase of mortality in hip fracture patients [ 10 ], the high mortality rate in the first year after fracture made this period most critical. Several factors have been identified related to the mortality of patients after surgery, such as increased age, male gender, ASA (American Society of Anesthesiologists) grade, types of surgery patients received, and walking ability before fracture [ 11 , 12 ]. However, the results were controversial.…”

Section: Introductionmentioning

confidence: 99%

One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry

et al. 2018

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BackgroundThe purpose of this registry-based retrospective study was to investigate the risk factors related to one-year mortality in displaced intracapsular fragility hip fracture patients.MethodsPatients were screened from the Fragility Fracture Registry. Inclusion criterion was displaced intracapsular hip fracture patients with atypical or pathological fractures excluded. One-year mortality was investigated against risk factors including age, gender, past medical history, pre-fracture mobility (PFM), pre-operation ASA grade, delayed surgery over 48 h, post-surgical complications, and length of stay at acute orthopedic ward (LOS).ResultsA total of 1050 patients were included for further analysis. Gross one-year mortality was 14.9%. One-year mortality was significantly higher in patients who received non-operative treatment and those who received surgery but delayed over 48 h after admission (both p < 0.001). Male gender (OR = 2.708), advanced age (OR = 1.359), higher risk ASA grades (III to V) (OR = 1.990), past history of gastrointestinal disease (OR = 1.671), and renal impairment (OR = 1.984) were related to higher one-year mortality. The mortality of patients in PFM grade 3 and LOS group 3 was significantly higher (OR = 2.240 and 1.722, respectively).ConclusionsHigher age, male gender, past gastrointestinal disease and renal impairment, ASA grade over 3, indoor confined pre-fracture ambulatory, and stay at hospital over 15 days were risk factors related to higher one-year mortality in surgically treated displaced intracapsular hip fracture patients. A multi-disciplinary approach is advised to patients identified with these risks factors and co-managed by orthopedic surgeons, geriatricians, and fracture liaison nurses.

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Walking ability before and after a hip fracture in elderly predict greater long-term survivorship

Cited by 32 publications

References 29 publications

Objectively Measured Physical Activity and Its Association with Functional Independence, Quality of Life and In-Hospital Course of Recovery in Elderly Patients with Proximal Femur Fractures: A Prospective Cohort Study

Objectively Measured Physical Activity and Its Association with Functional Independence, Quality of Life and In-Hospital Course of Recovery in Elderly Patients with Proximal Femur Fractures: A Prospective Cohort Study

Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta‐Analysis

One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry

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