Functional outcome after hip fracture: A 1-year prospective outcome study of 275 patients

doi:10.1016/S0020-1383(02)00414-X

Injury

Volume 34, Issue 7, July 2003, Pages 529-532

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Abstract

Two hundred and seventy-five consecutive patients over the age of 50 years admitted with a hip fracture were prospectively studied in detail, to assess the impact of a hip fracture on their functional ability and their need for social support. One hundred and eighty-three (66.9%) patients survived to 1 year. Mortality was highest amongst those least able to perform the recorded activities. One hundred and fifty-eight (86%) of the survivors were resident in the same level of accommodation after 1 year. There was a reduction in mobility and related functions of 20–25% and a reduction of 5% in tasks not related to hip function. It is therefore estimated that in the year after a hip fracture there will be decline in functionally abilities of about 5% unrelated to the hip fracture and about 15–20% directly related to the hip fracture. There was an increase in the requirement for social support amongst survivors individually, but overall the total economic burden on social services and institutional care was not significantly changed by hip fracture.

Introduction

Hip or proximal femoral fractures are a common injury, which has an increasing incidence within the ageing population. For the UK, an estimated 58,970 hospital admissions for hip fracture were recorded in 1993–1994 3. The world-wide incidence was estimated to be 1.3 million hip fractures in 1990. This figure is expected to rise to 2.6 million by 2025 and 4.5 million by 2050 4. This increased incidence has produced predictions of the high expense of caring for patients after hip fractures in terms of resources and medical time. These are largely based on outcome studies that have produced varying results 2., 6., 7., 14.. There is also an unrealistic perception in both medical literature and amongst the public at large concerning the consequences of hip fracture and the characteristics of the patient population 11.

These reported outcomes did not match our own experience and we have therefore prospectively followed up a cohort of patients presenting to a single unit in 1998. This is intended to determine in depth the effect of a hip fracture on functional ability and independence when managed by contemporary methods.

Section snippets

Patients and methods

Data was collected prospectively using the standardised audit guidelines recommended for Europe (SAHFE) 9 at a single district general hospital for the period from 1 January to 31 December 1998. Included were all those aged 50 years and above with a hip fracture, this comprised intracapsular, trochanteric or sub-trochanteric fractures of the femur up to a level of 5 cm distal to the lower border of the lesser trochanter. Pathological fractures of the hip secondary to a localised bone abnormality

Results

Over the year a total of 275 patients were admitted. The mean age was 81.1 years (range 51–103 years) and 58 (21.1%) were male. The fracture types were: 28 (10.2%) undisplaced intracapsular, 133 (48.4%) displaced intracapsular, 8 (2.9%) basal cervical, 18 (6.5%) stable trochanteric, 81 (29.4%) unstable trochanteric, and 7 (2.5%) sub-trochanteric. The treatment of these fractures was as follows: sliding hip screws (111 cases), three parallel cancellous screws (75 cases), hemiarthroplasty (78

Discussion

The aim of this study was to accurately document the outcome for a consecutive series of hip fracture patients. This enables the expected outcome for patients treated by current methods to be more accurately described. A hip fracture is generally felt to be a significant adverse event with a poor outcome. This perception has been reinforced by a number of recent papers that have quoted outcomes that do not match those that we have observed. Some of these papers do not report consecutive

Conclusion

The results of this study indicate that the 1-year mortality for a hip fracture is 33.1%, being higher for those from a more dependent level of care and higher for those of who are restricted in both basic and advanced activities of daily living. For the survivors, there is a decline in the ability to complete daily living tasks of between about 20 and 25%. Approximately 5% of this loss of function is due to the normal decline with ageing and the remainder secondary to the hip fracture.

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Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials
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Functional outcome after hip fracture: A 1-year prospective outcome study of 275 patients

Abstract

Introduction

Section snippets

Patients and methods

Results

Discussion

Conclusion

Public Health

The long-term results of low friction arthroplasty of the hip performed as a primary intervention

J. Bone Joint Surg. Br.

The crippling consequences of hip fracture and the impact on quality of life

Am. J. Med.

World-wide projections for hip fracture

Osteoporos. Int.

Mortality and morbidity after hip fractures

Br. Med. J.

Predictors of functional recovery after hip fracture

Clin. Orthop.