Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: a retrospective analysis

Background/aim: Hip fractures in older adults are associated with high morbidity, mortality, and subsequent hospital costs and decreased quality of life. The objective of this study was to evaluate geriatric patients who underwent partial prosthesis surgery following hip fracture and effects of early mobilization and weight bearing on postoperative walking ability and pain. Materials and methods: A total of 52 geriatric patients with intertrochanteric and femoral neck fractures were included in the study. Patients' service files, system records, pre- and postoperative X-rays were retrospectively reviewed.Results: There were 52 patients in the study group with 36 69.2% being female. The mean age of the patients was found as 82.9 ± 6.5 years. The mean length of stay in hospital was found as 6.2 ± 2.6 days. The mean length of stay in hospital was found as 5.3 ± 1.7 days in male and 6.6 ± 2.8 days in female patients, and the difference was statistically significant P = 0.035 . The mean length of stay in hospital was found as 5.4 ± 1.8 days in early mobilization group and 6.9 ± 2.9 days in late mobilization group, and the difference was statistically significant P = 0.026 . There was a significant difference between Harris and pain scores in terms of the time of first weight bearing at the postoperative 1st month follow-up. Harris score was found as 84.0 ± 5.8 median: 84.0, min-max: 73-94 , and the main pain score as 36.8 ± 6.8 in the group with the first weight bearing within the first 24 h, while Harris score was found as 71.10 ± 2.8, and the main pain score as 24.4 ± 6.4 in the group with the first weight bearing after the postoperative 24th hour.Conclusion: The results of our study indicated that early mobilization and full weight bearing in geriatric patients after hip fracture surgery shortened length of stay in hospital, reduced postoperative pain, and increased walking ability.

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  • 1. Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clinical Interventions in Aging 2018; 13: 143-150. doi: 10.2147/CIA.S150067.
  • 2. Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES. Impact of recent fracture on health-related quality of life in postmenopausal women. Journal of Bone and Mineral Research 2006; 21: 809-816. doi: 10.1359/jbmr.060301
  • 3. Davison J, Bond J, Dawson P, Steen N, Kenny RS. Patients with recurrent falls attending accident & emergency benefit from multifactorial intervention—a randomised controlled trial. Age Ageing 2005; 34: 162-168. doi: 10.1093/ageing/afi053
  • 4. Gallagher JC, Melton LJ, Riggs BL, Bergstrath E. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clinical Orthopaedics and Related Research 1980; 150: 163- 171
  • 5. Gullberg B, Johnell O and Kanis JA. World-wide projections for hip fracture. Osteoporosis International 1997; 7: 407-413. doi: 10.1007/pl00004148
  • 6. Gill TM, Allore H, Guo Z. The deleterious effects of bed rest among community-living older persons. Journals of Gerontology Series A 2004; 59 (7): 755-761. doi: 10.1093/ gerona/59.7.m755
  • 7. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ et al. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ Journal of Surgery 2006; 76: 607-611. doi: 10.1111/j.1445-2197.2006.03786.x
  • 8. Mallory TH. Preparation of the proximal femur in cementless total hip revision. Clinical Orthopaedics and Related Research 1988; 235: 47-60.
  • 9. Laflamme GY, Rouleau DM, Leduc S, Roy L, Beaumont E. The timed up and go test is an early predictor of functional outcome after hemiarthroplasty for femoral neck fracture. Journal of Bone Joint Surgery 2012; 94 (13): 1175-1179. doi: 10.2106/JBJS.J.01952
  • 10. Baer M, Neuhaus V, Pape HC, Ciritsis B. Influence of mobilization and weight bearing on in-hospital outcome in geriatric patients with hip fractures. SICOT J 2019; 5: 4. doi: 10.1051/sicotj/2019005
  • 11. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end‐ result study using a new method of result evaluation. Journal of Bone Joint Surgery 1969; 51: 737-755.
  • 12. Mont MA, Jacobs JJ. American Academy of Orthopaedic Surgeons clinical practice guideline: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. Journal of the American Academy of Orthopaedic Surgeons 2011; 19 (12): 777-778. doi: 10.2106/ JBJS.9408.ebo746
  • 13. Husted H, Otte KS, Kristensen BB, Orsnes T, Wong C et al. Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthopaedica 2010; 81 (5): 599-605. doi: 10.3109/17453674.2010.525196.
  • 14. Sankarlingam P, Shivraj V, Subramaniyam VR. Immediate mobilisation with complete weight bearing after uncemented total hip replacement in elderly. International Journal of Medical Research & Health Sciences 2014; 3(4): 929-932. doi: 10.5958/2319-5886.2014.00027.7
  • 15. Ottesen TD, McLynn RP, Galivanche AR, Bagi PS, Zogg CK et al. Increased complications in geriatric patients with a fracture of the hip whose postoperative weight-bearing is restricted: an analysis of 4918 patients. Bone Joint Journal 2018; 100-B (10): 1377-1384. doi: 10.1302/0301-620X.100B10.BJJ-2018-0489.R1
  • 16. Kamel HK, Iqbal MA, Mogallapu R, Maas D, Hoffmann RG. Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. Journals of Gerontology Series A 2003; 58: 1042-1045. doi: 10.1093/gerona/58.11.m1042
  • 17. Kamel HK. The frequency and factors linked to a urinary tract infection coding in patients undergoing hip fracture surgery. Journal of the American Medical Directors Association 2005; 6 (5): 316-320. doi: 10.1016/j. jamda.2005.04.005
  • 18. Falck - Ytter Y, Francis CW, Johanson NA et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of chest physicians evidence-based clinical practice guidelines. Chest 2012; 141 (2 Suppl): e278S-e325S. doi: 10.1378/ chest.11-2404
  • 19. Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. Journal of the American Geriatrics Society 2000; 48: 618-624. doi: 10.1111/j.1532- 5415.2000.tb04718.x
  • 20. Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. Journal of Bone Joint Surgery 2013; 95-A: 775-782. doi: 10.2106/JBJS.L.00211
  • 21. Chen LH, Liang J, Chen MC, Wu CC, Cheng HS. The relationship between preoperative American Society of Anesthesiologists Physical Status Classification scores and functional recovery following hip-fracture surgery. BMC Musculoskelet Disord 2017; 18 (1): 410. doi: 10.1186/s12891- 017-1768-x
  • 22. Leali A, Fetto J, Moroz A. Prevention of thromboembolic disease after non-cemented hip arthroplasty. A multimodal approach. Acta Orthopaedica Belgica 2002; 68 (2): 128-134.
  • 23. Creditor, MC. Hazards of hospitalization of the elderly. Annals of Internal Medicine 1993; 118 (3): 219-223. doi: 0.7326/0003- 4819-118-3-199302010-00011
  • 24. Harper CM, Lyles YM. Physiology and complications of bed rest. Journal of the American Geriatrics Society 1998; 36 (11): 1047-1054. doi: 10.1111/j.1532-5415.1988.tb04375.x
  • 25. d’Aubigne RM, Postel M. The classic: functional results of hip arthroplasty with acrylic prosthesis.1954. Clinical Orthopaedics and Related Research 2009; 467 (1): 7-27. doi: 10.1007/s11999-008-0572-1
  • 26. Parker M J, Palmer C R. A new mobility score for predicting mortality after hip fracture. Journal of Bone Joint Surgery (Br) 1993; 75: 797-798.
  • 27. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology 1994; 49 (2): M85-94. doi: 10.1093/ geronj/49.2.m85
  • 28. Zhang J, Ang ML, Kwek EB. Who will walk again? Effects of rehabilitation on the ambulatory status in elderly patients undergoing hemiarthroplasty for femoral neck fracture. Geriatric Orthopaedic Surgery & Rehabilitation 2015; 6 (3): 168-172. doi: 10.1177/2151458515583111
  • 29. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000; 93 (4): 1123-1133. doi: 10.1097/00000542-200010000-00038
  • 30. Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain 2011; 152 (3): 566-572. doi: 10.1016/j.pain.2010.11.023
  • 31. Clarke H, Kay J, Mitsakakis N, Katz J. Acute pain after total hip arthroplasty does not predict the development of chronic postsurgical pain 6 months later. Journal of Anesthesia 2010; 24 (4): 537-543. doi: 10.1007/s00540-010-0960-z
  • 32. Ramsay MA. Acute postoperative pain management. Proceedings (Baylor University. Medical Center) 2000; 13 (3): 244-247. doi: 10.1080/08998280.2000.11927683
  • 33. Robinson KP, Wagstaff KJ, Sanghera S, Kerry RM. Postoperative pain following primary lower limb arthroplasty and enhanced recovery pathway. Annals of the Royal College Surgeons of England 2014; 96 (4): 302-306. doi: 10.1308/003588414X13946 184900525
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