Factors predictive of functional outcomes in patients with fragility hip fracture

Abstract Background: To determine the predictors of functional outcomes of patients with surgically treated for fragility hip fracture Methods: This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 165 patients (43 males and 122 females; average age 81.1±6.8 years) who had undergone surgery for fragility hip fracture were followed up from immediately after surgery to 6 months postoperatively. The factors expected to be related to the functional outcomes at 6 months post-surgery were as follows: Baseline demographics, fracture site, operation type, fall characteristics including fall location and fall direction, comorbidities, initial functional status. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, dementia, cerebrovascular accident, and osteoporosis. Functional outcome measures were represented using the Koval’s grade, Functional Ambulatory Category (FAC), Berg balance scale (BBS), 4-meter walking speed test (4MWT), Korean version of Mini-Mental State Examination (K-MMSE), EuroQol five-dimension (EQ-5D) questionnaire, Korean version of Modified Barthel Index (K-MBI) and Korean version of instrumental activities of daily living (K-IADL). For all tests, each patient was assessed immediately after transfer and at 6 months post-surgery. In addition, since it was a multicenter study, hospital factors were also included as independent variables. Results: Multivariable regression analyses adjusting for age, sex, hospital, fracture site, operation type, fall location, fall direction, initial variables of the functional outcomes and comorbidities were as follows. Old age led to significantly less favorable outcome on FAC and K-IADL at 6 months. Intertrochanteric fracture had a significantly positive impact on Koval at 6 months compared to femur neck and intertrochanteric fractures. Total hip replacement arthroplasty had a significantly positive impact on EQ-5D at 6 months compared to bipolar hemiarthroplasty (BPH) and reduction and internal fixation. BPH had a significantly positive outcome on FAC at 6 months compared to other operation types. Fall characteristics didn’t reveal any significant impact on functional outcomes. Patients with hypertension had a significantly negative outcome on EQ-5D and patients with diabetes mellitus had a significantly less favorable outcome on K-IADL. Among Initial functional assessments, initial 4MWT was an independent predictor of Koval, BBS, 4MWT, K-MMSE and K-MBI at 6 months. Initial K-MMSE was significantly associated with BBS, K-MMSE and K-MBI 6 months. Initial K-IADL was an independent predictor of Koval and 4MWT at 6 months and Initial K-MBI was an independent predictor of K-IADL at 6 months.Conclusion: This study confirmed that age, fracture site, operation type, comorbidities and initial function significantly influenced functional recovery at 6 months in patients with fragility hip fracture.