The Timed Up and Go Test Is an Early Predictor of Functional Outcome After Hemiarthroplasty for Femoral Neck Fracture
ABSTRACT The ability to predict the long-term physical function and prognosis of hip fracture patients during the early postoperative period is essential for surgeons and physical therapists as well as for patients and their families. The purpose of this study was to determine whether early functional assessment correlated with and/or predicted long-term function after surgery to treat a displaced femoral neck fracture.
Sixty-two patients undergoing hemiarthroplasty for a displaced femoral neck fracture were evaluated prospectively; a minimum follow-up of two years was required. Validated functional assessments, including the Lower Extremity Measure and the Timed Up and Go test, were utilized, and scores were analyzed with respect to patient baseline data.
The functional level of patients decreased significantly after the injury, with the mean Lower Extremity Measure score decreasing from 87.7 to 62.4 and the need for a walking aid increasing from 36% to 54% at two years postoperatively (p < 0.05 for both). The Timed Up and Go test scores at four days and three weeks postoperatively were significantly higher in patients who needed a walking aid at two years compared with independently walking patients (p < 0.05). Receiver operating characteristic curve analysis of the Timed Up and Go test scores revealed that the optimal threshold for predicting the need for a walking aid at two years was fifty-eight seconds at four days postoperatively and twenty-six seconds at three weeks. Also, the need for a walking aid at two years was ninetyfold higher when the Timed Up and Go test score at three weeks postoperatively exceeded the twenty-six seconds threshold.
The Timed Up and Go test was an early clinical indicator of future physical function in patients with a hip fracture treated with hemiarthroplasty. Innovative clinical approaches to anticipate future function will contribute to increasing the efficiency of overall management of this growing set of patients.
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ABSTRACT: The Direct Anterior Approach (DAA) is well established as a minimal access approach in elective orthopaedic hip surgery. For the growing number of elderly patients with femoral neck fractures treated with Bipolar Hip Hemiarthroplasty (BHH), only a few results do exist. The study shows the clinical and radiological outcome for 180 patients treated by a modified DAA with BHH.The Open Orthopaedics Journal 07/2014; 8(1):225-31. DOI:10.2174/1874325001408010225This article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures. HEALTH is a multicentre, randomised controlled trial where 1434 patients, 50 years of age or older, with displaced femoral neck fractures from international sites are randomised to receive either THA or HA. Exclusion criteria include associated major injuries of the lower extremity, hip infection(s) and a history of frank dementia. The primary outcome is unplanned secondary procedures and the secondary outcomes include functional outcomes, patient quality of life, mortality and hip-related complications-both within 2 years of the initial surgery. We are using minimisation to ensure balance between intervention groups for the following factors: age, prefracture living, prefracture functional status, American Society for Anesthesiologists (ASA) Class and centre number. Data analysts and the HEALTH Steering Committee are blinded to the surgical allocation throughout the trial. Outcome analysis will be performed using a χ(2) test (or Fisher's exact test) and Cox proportional hazards modelling estimate. All results will be presented with 95% CIs. The HEALTH trial has received local and McMaster University Research Ethics Board (REB) approval (REB#: 06-151). Outcomes from the primary manuscript will be disseminated through publications in academic journals and presentations at relevant orthopaedic conferences. We will communicate trial results to all participating sites. Participating sites will communicate results with patients who have indicated an interest in knowing the results. The HEALTH trial is registered with clinicaltrials.gov (NCT00556842). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.BMJ Open 5(2):e006263. DOI:10.1136/bmjopen-2014-006263 · 2.06 Impact Factor
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ABSTRACT: The aim of the present study was to determine the independent factors influencing mobilization progress after geriatric hip fractures. 392 hip fracture patients older than 60 years were included in this prospective, observational, cohort study. The progress of mobilization was measured with walking ability 4 days post-surgery, ability to climb stairs until discharge and the Tinetti test at discharge. Factors correlated with the progress of mobilization were determined using multivariate analyses. The independent factors influencing walking ability 4 days post-surgery were the pre-fracture Charlson Comorbidity Index (OR = 0.834, p = 0.005), the American Society of Anesthesiologists Score (OR = 0.550, p = 0.013), pre-fracture Barthel Index ([BI], OR = 1.019, p = 0.012) and risk for depression, as measured by the Geriatric Depression Scale, (OR = 0.896, p = 0.013). The probability of climbing stairs until discharge was influenced by the patient's age (OR = 0.840, p < 0.001), pre-fracture BI (OR = 1.047, p = 0.042), cognitive impairment, as measured by the Mini Mental State Examination (OR = 1.182 p = 0.008), pre surgical hemoglobin (OR = 1.026, p = 0.044), time until surgery (OR = 0.961, p = 0.023), duration of surgery (OR = 0.982, p = 0.014), and surgery type (prosthesis, OR = 4.545, p = 0.001). Similar variables influenced the Tinetti test ad discharge. While pre-fracture co-morbidities and function cannot be changed, the treatment of patients with cognitive impairment and depressive symptoms should be optimized. Efforts should be undertaken to ensure early surgery for all hip fractures.Archives of Gerontology and Geriatrics 02/2015; DOI:10.1016/j.archger.2015.01.017 · 1.53 Impact Factor