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Loss of Independence After Operative Management of Femoral Neck Fractures

Schemitsch, Emil H., MD, FRCSC*; Sprague, Sheila, PhD†,‡; Heetveld, Martin J., MD§; Bzovsky, Sofia, MSc; Heels-Ansdell, Diane, MSc; Zhou, Qi, PhD; Swiontkowski, Marc, MD; Bhandari, Mohit, MD, PhD, FRCSC†,‡

Journal of Orthopaedic Trauma: June 2019 - Volume 33 - Issue 6 - p 292–300
doi: 10.1097/BOT.0000000000001444
Original Article
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Objectives: The FAITH trial evaluated effects of sliding hip screws versus cancellous screws in femoral neck fracture patients. Using FAITH trial data, we quantified changes in living status, use of aids, and investigated factors associated with living and walking independently 12 months after fracture.

Methods: We conducted a descriptive analysis to quantify patients' changes in living status, use of aids, and used multivariable Cox regression analyses to determine factors associated with living and walking independently after fracture.

Results: Of patients who lived independently before hip fracture, 3.07% (50–80 years old) and 19.81% (>80 years old) were institutionalized 12 months after injury. Of patients who were walking independently before injury, 33.62% (50–80 years old) and 69.34% (>80 years old) required a walking aid 12 months after injury. Factors associated with higher chances of living independently included the following: being between 50 and 80 years, having a class I American Society of Anesthesiologists classification, not using a walking aid before fracture, being a nonsmoker or former smoker, and having an acceptable quality of implant placement. Factors associated with higher chances of walking without an aid included the following: being between 50 and 80 years, having a class I American Society of Anesthesiologists classification, living independently before fracture, being a nonsmoker or former smoker, having an undisplaced fracture, and not requiring revision surgery.

Conclusions: Femoral neck fracture patients suffer great losses of independence. Identifying factors associated with living and walking independently after hip fracture may help surgeons better identify which patients are at risk and optimize care of patients with this injury.

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

*Department of Surgery, University of Western Ontario, London, ON, Canada;

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada;

Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada;

§Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands; and

Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.

Reprints: Emil H. Schemitsch, MD, FRCSC, Department of Surgery, University of Western Ontario, 339 Windermere Rd, Box 5339, London, ON N6A 5A5 (e-mail: Emil.Schemitsch@lhsc.on.ca).

The FAITH study was supported by research grants from the Canadian Institutes of Health Research (MOP-106630 and MCT-87771), the National Institutes of Health (1R01AR055267-01A1), Stichting NutsOhra (SNO-T-0602-43), the Netherlands Organization for Health Research and Development (80-82310-97-11032), and Physicians' Services Incorporated.

E. H. Schemitsch reports personal fees from Stryker, personal fees from Smith & Nephew, personal fees from Zimmer, personal fees from Acumed, personal fees from Amgen, personal fees from Sanofi, and personal fees from Pendopharm, outside the submitted work. S. Sprague reports employment/salary from McMaster University, and other from the Global Research Solutions, outside the submitted work. M. J. Heetveld reports grants from Stichting NutsOhra, grants from the Netherlands Organization for Health Research and Development, during the conduct of the study. M. Swiontkowski reports grants from the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), during the conduct of the study; other from JBJS Editor, outside the submitted work. M. Bhandari reports grants from the Canadian Institutes of Health Research, grants from the National Institutes of Health, grants from Stichting NutsOhra, grants from the Netherlands Organization for Health Research and Development, grants from Physicians' Services Incorporated, and grants from Stryker Inc, during the conduct of the study; grants and personal fees from Stryker Inc, personal fees from Smith & Nephew, grants and personal fees from Amgen, grants from DePuy, grants and personal fees from Eli Lilly, grants and personal fees from DJO Global Inc, personal fees from Zimmer, personal fees from Ferring, and grants from the Canada Research Chair in Musculoskeletal Trauma, outside the submitted work. The remaining authors have no conflicts of interest.

Presented in part at the Annual Meeting of the Orthopaedic Trauma Association, October 11, 2017, Vancouver, BC, Annual Meeting of the American Academy of Orthopaedic Surgeons, March 8, 2018, New Orleans, LA, and at the Annual Meeting of the Canadian Orthopaedic Association, June 20–23, 2018, Victoria, BC.

Members of FAITH Investigators are listed in Appendix 1.

Accepted December 29, 2018

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