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The association between weight-bearing status and early complications in hip fractures

  • Original Article • HIP - FRACTURES
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Early mobilization and weight-bearing have been proposed to improve hip fracture outcomes. This study aimed to compare early postoperative complications and outcomes of patients who underwent weight-bearing as tolerated (WBAT) on postoperative day one (POD1) with those that did not on: (1) 30-day mortality; (2) 30-day postoperative major and minor complications; (3) length of stay (LOS); and (4) discharge disposition after hip fracture management.

Methods

The NSQIP database was used to identify 7947 hip fracture patients managed with a hemiarthroplasty and internal fixation, sliding hip screw, or cephalomedullary nail, for a total of 5845 patients were allowed to WBAT on POD1. They were compared to patients who were non-WBAT using adjusted multivariate regression models to evaluate the effect of WBAT status on the outcomes above.

Results

Among the cephalomedullary nail patients, WBAT on POD1 was associated with a decreased likelihood of mortality. In the cephalomedullary nail and sliding hip screw treatment groups, patients were less likely to experience major and minor complications if they were WBAT on POD1. WBAT patients had shorter LOS in the sliding hip screw and cephalomedullary nail treatment groups. Patients were less likely to be discharged to a non-home facility when WBAT on POD1 regardless of treatment.

Conclusion

Early weight-bearing after surgical care of hip fracture seems to decrease morbidity and mortality; however, this effect is treatment dependent. These findings further support the need for early mobilization and rapid recovery programs in the care of hip fracture patients.

Level of evidence

Level III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue/A41, Cleveland, OH, 44195, USA

    Jared Warren, Kavin Sundaram, Hiba Anis, John McLaughlin, Brendan Patterson & Nicolas S. Piuzzi

  2. Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Carlos A. Higuera

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  1. Jared Warren
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  2. Kavin Sundaram
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Correspondence to Nicolas S. Piuzzi.

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Conflict of interest

The authors declare that they have no conflict of interest. Board and committee member of the Orthopaedic Trauma Association, American Association of Hip and Knee Surgeons, Mid-American Orthopaedic Association, and Musculoskeletal Infection Society. Editorial or governing board member of American Journal of Orthopedics, Journal of Hip Surgery, Journal of Knee Surgery. Research support from CD Diagnostics, Cymedica, KCI, OREF, Ferring Pharmaceuticals, OrthoFix, Inc, Stryker, Zimmer. Paid Consultant for Zimmer and KCI. Paid presenter for KCI. Stock or stock options in PSI.

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Warren, J., Sundaram, K., Anis, H. et al. The association between weight-bearing status and early complications in hip fractures. Eur J Orthop Surg Traumatol 29, 1419–1427 (2019). https://doi.org/10.1007/s00590-019-02453-z

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  • DOI: https://doi.org/10.1007/s00590-019-02453-z

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