Fixation Versus Replacement in Geriatric Hip Fractures: Does Functional Outcome and Independence in Self-Care Differ?

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Rehabilitation Science

Background:

• Geriatric hip fractures pose significant challenges to functional recovery and independence.
• Integrated care pathways aim to optimize outcomes for these patients.
• The comparative functional recovery between surgical fixation and arthroplasty remains unclear.

Purpose of the Study:

• To compare functional recovery of activities of daily living (ADL) and self-care independence.
• To evaluate differences between internal fixation and arthroplasty in surgically treated hip fractures.

Main Methods:

• A cohort study comparing 213 patients undergoing internal fixation (Group A) with 199 patients undergoing arthroplasty (Group B).
• Data collected included demographics, comorbidity scores (Charlson Comorbidity Index - CCI), time to surgery, and length of stay.
• Functional status was assessed using the Modified Barthel Index (MBI) pre-injury, at discharge, and at 6 months and 1 year post-surgery.

Main Results:

• No significant differences in age, CCI, or length of stay between groups.
• Arthroplasty group had a shorter time to surgery (86.6 hours vs. 102.2 hours).
• While pre-injury MBI differed, MBI scores at discharge, 6 months, and 1 year showed no significant difference between groups. Arthroplasty patients recovered a higher percentage of pre-injury function (94.1% vs. 88.1%).

Conclusions:

• The Modified Barthel Index (MBI) effectively measures self-care independence and functional recovery.
• Surgical approach (fixation vs. arthroplasty) may not be a significant determinant of one-year self-care independence.
• Arthroplasty demonstrated a trend towards greater functional recovery at one year post-surgery.