Age Is the Most Important Predictor for Regaining Independence After Hip Fracture
Most middle-aged and older adults recover their ability to live independently within a year after surgery for hip fracture, according to a study published in the Journal of Orthopaedic Trauma.
Even patients older than 80 are usually able to resume living independently – although they’re less likely to regain independent walking ability, according to new research from the University of Western Ontario. According to the researchers, “Identifying factors associated with living and walking independently following hip fracture may help surgeons better identify which patients are at risk and optimize care of patients with this injury.”
The study included more than 600 patients age 50 or older who underwent surgery for femoral neck fracture. These patients had participated in the recently completed FAITH (Fixation using Alternative Implants for the Treatment of Hip fractures) randomized controlled trial, which had compared 2 types of bone screws – cancellous screws and a sliding hip screw – for fracture repair in 1,079 patients from 81 clinical sites. The new analysis from the University of Western Ontario included only patients who were living and/or walking independently before their hip fracture.
In the new analysis, the researchers included only those patients for whom they had 1 year of follow-up data indicating whether the patients had returned to independent, non-institutionalized living and independent walking, without any type of walking aid. The goals of the study were to:
- Descriptively quantify patients’ changes in living status and use of walking aids in the year after hip fracture
- Identify factors predicting a greater chance of returning to independent living and independent mobility
One year after hip fracture, 3% of patients who were 50 to 80 year old at the time of surgery were living in some type of institution, compared with 20% of patients older than 80. Of those who were walking independently before hip fracture, 34% of 50- to 80-year-old patients required some type of walking aid, as did 69% of those in the over-80 group.
Age between 50 and 80 years old was a strong predictor of returning to independent living and independent walking 1 year after hip fracture surgery. Patients with good fitness before surgery (ASA I) and current non-smokers were also more likely to regain independent living and independent walking ability within 1 year of hip fracture.
Patients who were not using a walking aid before their hip fracture and those having “acceptable” hip implant placement were also more likely to return to independent living. Predictors of independent walking included living independently before fracture, having a non-displaced fracture, and not needing revision surgery.
The study findings suggest that most patients age 50 to 80 will be able to live and walk independently by 1 year after hip fracture. Patients over age 80 also have a good chance of returning to independently living, although they will likely need some kind of walking aid. In addition to age, previous physical fitness, smoking, certain fracture characteristics, and undergoing revision surgery to the hip also affect the chances of regaining independence.
The researchers concluded that, “Identifying factors associated with living and walking independently following a hip fracture may help the orthopaedic community better identify which patients are at risk for loss of independence and mobility following a hip fracture, and ultimately help to optimize the care of patients with this type of injury.”
Schemitsch EH, Sprague S, Heetveld MJ, et al. Loss of independence after operative management of femoral neck fractures. J Orthop Trauma. 2019 Feb 18. doi: 10.1097/BOT.0000000000001444. [Epub ahead of print]