Skip to main content

Advertisement

SpringerLink
Log in

Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background and purpose

Reduced mobility is a severe threat to the clinical outcomes and survival of elderly hip fracture patients. These patients generally struggle to comply with partial weight bearing, yet postoperative weight-bearing restrictions are still recommended by nearly 25% of surgeons. Therefore, we hypothesized that weight-bearing restrictions in elderly hip fracture patients merely leads to reduced mobility, while transposing full weight to the fractured extremity remains unaffected disregarding the prescribed aftercare.

Patients and methods

41 equally treated patients with pertrochanteric fractures were enrolled consecutively in a maximum care hospital in a pre–post study design (level of evidence 2). A study group of 19 patients was instructed to maintain partial weight bearing (PWB), whereas the control group of 22 patients was instructed to mobilize at full weight bearing (FWB). All patients were asked to participate in a gait analysis using an insole force sensor (loadsol®, Novel, Munich, Germany) on the fifth postoperative day.

Results

The postoperative Parker Mobility Score in the PWB group compared to the FWB group was significantly reduced (3.21 vs. 4.73, p < 0.001). Accordingly, a significantly lower gait speed in the PWB group of 0.16 m/s vs. 0.28 m/s was seen (p = 0.003). No difference in weight bearing was observed in between the groups (average peak force 350.25 N vs. 353.08 N, p = 0.918), nor any differences in the demographic characteristics, ASA Score, Barthel Index or EQ5D.

Interpretation

Weight-bearing restrictions in elderly hip fracture patients contributed to a loss of mobility, while no significant differences in loading of the affected extremity were observed. Therefore, postoperative weight-bearing restrictions in elderly hip fracture patients should be avoided, to achieve early mobilization at full weight bearing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bohannon RW, Glenney SS (2014) Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review. J Eval Clin Pract 20(4):295–300. https://doi.org/10.1111/jep.12158

    Article  PubMed  Google Scholar 

  2. Braun BJ, Veith NT, Rollmann M, Orth M, Fritz T, Herath SC, Holstein JH, Pohlemann T (2017) Weight-bearing recommendations after operative fracture treatment—fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole. Int Orthop 41(8):1507–1512. https://doi.org/10.1007/s00264-017-3481-7

    Article  PubMed  Google Scholar 

  3. Brumback RJ, Uwagie-Ero S, Lakatos RP, Poka A, Bathon GH, Burgess AR (1988) Intramedullary nailing of femoral shaft fractures. Part II: fracture-healing with static interlocking fixation. J Bone Jt Surg Am Vol 70(10):1453–1462

    Article  CAS  Google Scholar 

  4. Dirks ML, Wall BT, van de Valk B, Holloway TM, Holloway GP, Chabowski A, Goossens GH, van Loon LJC (2016) One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes 65(10):2862–2875. https://doi.org/10.2337/db15-1661

    Article  CAS  PubMed  Google Scholar 

  5. Faul F, Erdfelder E, Buchner A, Lang A-G (2009) Statistical power analyses using G*power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160. https://doi.org/10.3758/BRM.41.4.1149

    Article  Google Scholar 

  6. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191

    Article  Google Scholar 

  7. Frenkel Rutenberg T, Vitenberg M, Haviv B, Velkes S (2018) Timing of physiotherapy following fragility hip fracture: delays cost lives. Arch Orthop Trauma Surg 138(11):1519–1524. https://doi.org/10.1007/s00402-018-3010-1

    Article  PubMed  Google Scholar 

  8. Hill K (2010) Additional physiotherapy during acute care reduces falls in the first 12 months after hip fracture. J Physiother 56(3):201. https://doi.org/10.1016/S1836-9553(10)70027-8

    Article  PubMed  Google Scholar 

  9. Kamel HK, Iqbal MA, Mogallapu R, Maas D, Hoffmann RG (2003) Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. J Gerontol Ser A Biol Sci Med Sci 58(11):1042–1045

    Article  Google Scholar 

  10. Kammerlander C, Gosch M, Kammerlander-Knauer U, Luger TJ, Blauth M, Roth T (2011) Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 131(10):1435–1444. https://doi.org/10.1007/s00402-011-1313-6

    Article  PubMed  Google Scholar 

  11. Kammerlander C, Pfeufer D, Lisitano LA, Mehaffey S, Böcker W, Neuerburg C (2018) Inability of older adult patients with hip fracture to maintain postoperative weight-bearing restrictions. J Bone Jt Surg Am Vol 100(11):936–941. https://doi.org/10.2106/JBJS.17.01222

    Article  Google Scholar 

  12. Knobe M, Münker R, Sellei RM, Schmidt-Rohlfing B, Erli HJ, Strobl CS, Niethard FU (2009) Unstable pertrochanteric femur fractures. Failure rate, lag screw sliding and outcome with extra- and intramedullary devices (PCCP, DHS and PFN). Zeitschrift Fur Orthopadie Und Unfallchirurgie 147(3):306–313. https://doi.org/10.1055/s-0029-1185349

    Article  CAS  PubMed  Google Scholar 

  13. Lauretani F, Meschi T, Ticinesi A, Maggio M (2017) ‘Brain-Muscle Loop’ in the fragility of older persons: from pathophysiology to new organizing models. Aging Clin Exp Res 29(6):1305–1311. https://doi.org/10.1007/s40520-017-0729-4

    Article  PubMed  Google Scholar 

  14. Lenich A, Vester H, Nerlich M, Mayr E, Stöckle U, Füchtmeier B (2010) Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip–blade vs screw. Injury 41(12):1292–1296. https://doi.org/10.1016/j.injury.2010.07.499

    Article  PubMed  Google Scholar 

  15. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79(3):274–278

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Morris AH, Zuckerman JD, AAOS Council of Health Policy and Practice, USA. American Academy of Orthopaedic Surgeons (2002) National consensus conference on improving the continuum of care for patients with hip fracture. J Bone Jt Surg Am Vol 84-A(4):670–674

    Google Scholar 

  17. Murena L, Moretti A, Meo F, Saggioro E, Barbati G, Ratti C, Canton G (2018) Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients. Arch Orthop Trauma Surg 138(3):351–359. https://doi.org/10.1007/s00402-017-2863-z

    Article  PubMed  Google Scholar 

  18. Ottesen TD, McLynn RP, Galivanche AR, Bagi PS, Zogg CK, LE Rubin, Grauer JN (2018) Increased complications in geriatric patients with a fracture of the hip whose postoperative weight-bearing is restricted. Bone Jt J 100-B(10):1377–1384. https://doi.org/10.1302/0301-620X.100B10.BJJ-2018-0489.R1

    Article  CAS  Google Scholar 

  19. Palombaro Kerstin M, Craik Rebecca L, Mangione Kathleen K, Tomlinson James D (2006) Determining meaningful changes in gait speed after hip fracture. Phys Ther 86(6):809–816

    PubMed  Google Scholar 

  20. Perracini MR, Kristensen MT, Cunningham C, Sherrington C (2018) Physiotherapy following fragility fractures. Injury 49(8):1413–1417. https://doi.org/10.1016/j.injury.2018.06.026

    Article  PubMed  Google Scholar 

  21. Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P (2009) Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977–2001. J Bone Miner Res 24(7):1299–1307. https://doi.org/10.1359/jbmr.090207

    Article  Google Scholar 

  22. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL (2010) The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 1(1):6–14. https://doi.org/10.1177/2151458510378105

    Article  PubMed  PubMed Central  Google Scholar 

  23. Schwachmeyer V, Damm P, Bender A, Dymke J, Graichen F, Bergmann G (2013) In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS One 8(10):e77807. https://doi.org/10.1371/journal.pone.0077807

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Siu AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS (2006) Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med 166(7):766–771. https://doi.org/10.1001/archinte.166.7.766

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wall BT, Dirks ML, van Loon LJC (2013) Skeletal muscle atrophy during short-term disuse: implications for age-related sarcopenia. Ageing Res Rev 12(4):898–906. https://doi.org/10.1016/j.arr.2013.07.003

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to Dr. Crispin for his help with the statistical analysis. We also want to thank Marissa Stagg and Leo Adolf Lisitano for help in realizing this paper.

Funding

Funding was received from Friedrich-Baur-Foundation, (Ref.No. 29/16). Deutsche Forschungsgemeinschaft/Max Kade Foundation, Postdoctoral Research Fellowship (PF 939/1-0).

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Utah, Salt Lake City, USA

    Daniel Pfeufer

  2. Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany

    Daniel Pfeufer, Anne Zeller, Stefan Mehaffey, Wolfgang Böcker, Christian Kammerlander & Carl Neuerburg

Authors
  1. Daniel Pfeufer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Zeller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Mehaffey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolfgang Böcker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Kammerlander
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carl Neuerburg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Pfeufer.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Ethics approval

The local universities’ ethics committee approved this study (Ref. No.: 214-16). All participants gave written informed consent before data collection began.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pfeufer, D., Zeller, A., Mehaffey, S. et al. Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients. Arch Orthop Trauma Surg 139, 1253–1259 (2019). https://doi.org/10.1007/s00402-019-03193-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-019-03193-9

Keywords

Search

Navigation