HSS Journal

, 4:43 | Cite as

Five-Year Survival in a Cohort of Hip Fracture Patients: The Predictive Role of Pre-fracture Health Status

  • Margaret G. E. Peterson
  • Charles N. Cornell
  • Stephen A. Paget
  • John P. Allegrante
Original Article


The aim was to assess the outcome of surgery at 5 years after hip fracture. In this prospective study, we analyzed 5-year survival of a cohort of 105 hip fracture patients as a function of preoperative health. The main outcome measurements were the status of the patient, dead or alive, and the SF-36 of their pre-fracture status as recalled during their hospital stay. In the fifth year post-hospitalization 58 patients were alive. There was a significant association between the recall SF-36 general health score and being alive in the fifth year (P = 0.0004) and with survival in general (P = 0.0001). This and prior studies support the concept of stratifying hip fracture patients according to pre-fracture health status when assessing outcomes of fracture repair or other interventions. This study further demonstrates the utility of the SF-36 for this purpose.

Key words

hip fracture survival elderly pre-fracture status functional recovery 



The authors wish to thank A. Augurt, BA and Randy Cohn, BA for help with data collection.

This study was undertaken with the support of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS 2P60-AR38520) and Hospital for Special Surgery and partially conducted in a facility constructed with support from Research Facilities Improvement Program Grant Number C06-RR12538-01 from the National Center for Research Resources, National Institutes of Health.


  1. 1.
    Popovic JR (2001) 1999 National hospital discharge survey: annual summary with detailed diagnostics and procedure data. National Center for Health Statistics. Vital Health Stat 13(151):23, 154Google Scholar
  2. 2.
    Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics (2002) National Hospital Discharge SurveyGoogle Scholar
  3. 3.
    US Census Bureau (2004) U.S. Interim projections by age, sex, race and Hispanic origin. Retrieved at: http://www.census.gov/ipc/www/usinterimproj/
  4. 4.
    Samuelson EJ, Zhang Y, Kiel DP et al. (2002) Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham study. Am J Public Health 92:858–862Google Scholar
  5. 5.
    Blofeldt R, Tornkvist H, Ponzer S et al. (2005) Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. J Bone Joint Surg 87A:1680–1688CrossRefGoogle Scholar
  6. 6.
    Goldhill V, Lyden JP, Cornell CN, Bochner RM (1991) Bipolar hemiarthroplasty for fracture of the femoral neck. J Orthop Trauma 5:318–324PubMedCrossRefGoogle Scholar
  7. 7.
    Kyle RF, Gustelo RB, Premer RF (1976) Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Jt Surg Am 61:216–221Google Scholar
  8. 8.
    Lu-Yao GL, Keller RB, Littenberg B, et al. (1994) Outcomes after displaced fractures of the femoral neck: a meta-analysis. J Bone Jt Surg 76A:15–25Google Scholar
  9. 9.
    Squires B, Bannister G (1999) Displaced intracapsular neck of the femur fractures in mobile independent patients: total hip replacement or hemiarthroplasty? Injury 30:345–348PubMedCrossRefGoogle Scholar
  10. 10.
    Tidermark J, Ponzer S, Svensson OH (2003) Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. a randomized, controlled trial. J Bone Jt Surg. [Br] 85:380–388CrossRefGoogle Scholar
  11. 11.
    Magaziner J, Lydick E, Hawkes W et al. (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87:1630–1636PubMedCrossRefGoogle Scholar
  12. 12.
    Wolinsky FD, Fitzgerald JF, Stump TE. (1997) The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 87:398–403PubMedGoogle Scholar
  13. 13.
    Barrett JA, Baron JA, Beach ML. (2003) Mortality and pulmonary embolism after fracture in the elderly. Osteoporos Int 14:889–894PubMedCrossRefGoogle Scholar
  14. 14.
    Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA (2005) Survival after hip fracture. Osteoporos Int 16:1583–1590PubMedCrossRefGoogle Scholar
  15. 15.
    Heinonen M, Karppi P, Huusko T et al. (2004) Post-operative degree of mobilization at two weeks predicts one-year mortality after hip factor. Aging Clin Exp Res 16:476–480PubMedGoogle Scholar
  16. 16.
    Jiang HX, Majumdar SR, Dick DA et al. (2005) Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fracture. J Bone Min Res 20:494–500CrossRefGoogle Scholar
  17. 17.
    Koval KJ, Skovron ML, Ahronoff GB, Zuckerman JD. (1998) Predictors of functional recovery after hip fracture in the elderly. Clin Orthop 348:22–28PubMedGoogle Scholar
  18. 18.
    Magaziner J, Hawkes W, Hebel JR et al. (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55A(9):M498–507Google Scholar
  19. 19.
    Patterson BM, Cornell CN, Carbone EA et al. (1992) Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Jt Surg [Am] 74:251–260Google Scholar
  20. 20.
    Peterson MGE, Allegrante JP, Cornell CN et al. (2002) Measuring recovery after a hip fracture using the SF-36 and Cummings scales. Osteoporosis Int 13:296–302CrossRefGoogle Scholar
  21. 21.
    Shabat S, Mann G, Gepstein R et al. (2004) Operative treatment for hip fractures in patients 100 years of age and older: is it justified? J Orthop Trauma 18:431–435PubMedCrossRefGoogle Scholar
  22. 22.
    Soderqvist A, Miedel R, Ponzer S, Tidermark J. (2006) The influence of cognitive function on outcome after a hip fracture. J Bone Joint Surg [Am] 88:2115–2123CrossRefGoogle Scholar
  23. 23.
    Wen M, Christakis NA (2005) Neighborhood effects on posthospitalization mortality: a population-based cohort study of the elderly in Chicago. Health Serv Res 40:1108–1127PubMedCrossRefGoogle Scholar
  24. 24.
    Donald IP, Bulpitt CJ (1999) The prognosis of falls in elderly people living at home. Age Aging 28:121–125CrossRefGoogle Scholar
  25. 25.
    Morrison RS, Magaziner J, Gilbert M et al. (2003) Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Geront 58:76–81Google Scholar
  26. 26.
    Mahomad NN, Barrett JA, Katz JN et al. (2003) Rates and outcomes of primary and revision total hip replacement in the United States Medicare population. JBJS 85A:27–32Google Scholar
  27. 27.
    Ishida Y, Kawai S, Taguchi T. (2005) Factors affecting ambulatory status and survival of patients 90 years and older with hip fractures. CORR 436:208–215CrossRefGoogle Scholar
  28. 28.
    Carpintero P, Lopez P, Leon F, Lluch M, Montero M, Aguilera C. (2005) Men with hip fractures have poorer nutritional status and survival than women: a prospective study of 165 patients. Acta Orthopaedica 76:331–335PubMedGoogle Scholar
  29. 29.
    Allegrante JP, Peterson MGE, Cornell CN et al. (2007) Methodological challenges in multiple-component intervention: lessons learned from a randomized controlled trial of functional recovery following hip fracture. HSS J 3:63–70CrossRefPubMedGoogle Scholar
  30. 30.
    Tinetti ME, Baker DI, Gottshalk M (1999) Home based multicomponent rehabilitation program for older persons after hip fracture. Arch Phys Med Rehab 80:916–922CrossRefGoogle Scholar
  31. 31.
    Ware JE, Snow KK, Kosinski M, Gandek B (1993) SF-36 Health Survey: Manual and Interpretation Guide. The Health Institute, New England Medical Center, Boston, MAGoogle Scholar
  32. 32.
    Ruchlin HS, Elkin EB, Allegrante JP (2001) The economic impact of a multifactorial intervention to improve postoperative rehabilitation of hip fracture patients. Arthritis Care Res 45:446–452CrossRefGoogle Scholar
  33. 33.
    Endo Y, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ (2005) Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthopaedic Trauma 19:29–35CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2007

Authors and Affiliations

  • Margaret G. E. Peterson
    • 1
    • 2
  • Charles N. Cornell
    • 3
  • Stephen A. Paget
    • 4
  • John P. Allegrante
    • 5
    • 6
  1. 1.Research DivisionHospital for Special SurgeryNew YorkUSA
  2. 2.Research DivisionHospital for Special SurgeryPlainvilleUSA
  3. 3.Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  4. 4.Department of RheumatologyHospital for Special SurgeryNew YorkUSA
  5. 5.Department of Health and Behavior StudiesTeachers College, Columbia UniversityNew YorkUSA
  6. 6.Department of Sociomedical SciencesMailman School of Public Health, Columbia UniversityNew YorkUSA

Personalised recommendations