Mobility Following Femoral Neck Fracture Surgery: Does Surgical Treatment Affect Physiotherapy Outcome?

Introduction: Many patients sustaining hip fracture do not regain their pre-injury function. Early rehabilitation improves outcome. The aim of this study was to investigate if hip fracture patients progressed differently following surgery depending on whether arthroplasty or internal fixation (IF) was employed. This information may be useful to identify patient cohorts who may require further rehabilitation prior to discharge home. Methods: A prospective database was used to audit outcomes for hip fracture patients presenting to our unit between October 2019 and October 2020. Our study group comprised 89 patients with femoral neck fractures. 60 patients were female, 29 were male. Average age was 77 years (range 50-96). 69 patients were treated by arthroplasty, 20 patients were treated with IF. The group treated by IF were younger (mean 71.4 years) compared to the group treated by arthroplasty (mean 79.3 years) (P = 0.0027). Timed Up and Go (TUG) test was performed as soon as patients were able to complete same post-operatively, and again at discharge, to assess difference over time. Results: 17 patients out of20 (85%) of the group treated with IF were able to perform a TUG test prior to discharge, at a mean of 4.3 (range 2-13) days post-operatively. Mean time taken to complete an initial TUG by the IF group was 74.7 seconds. Of the patients treated with arthroplasty, 54 out of 69 (78%) were able to complete a TUG prior to discharge, at a mean of 4.9 (range 1-16) days. The mean time taken to complete the initial TUG by a patient treated with arthroplasty was 87.8 seconds. By discharge the time taken to complete this distance had reduced in both groups with the arthroplasty group completing their TUG in a mean of 46 seconds (median 39 seconds) and the IF group completing the TUG in a mean of 55.7 seconds (median 46 seconds). Twenty-six (38%) of the patients treated with arthroplasty were dis-charged home directly, while eleven (55%) of the patients treated with IF were discharged home directly. Conclusion: Hip fracture patients treated with arthroplasty had lower functional ability on day one post-operatively compared to the IF group, however patients treated with arthroplasty showed the greatest improvement in function and mobility at the time of discharge. Despite this, a greater proportion of the IF group were discharged directly home (55% vs 38%) and able to receive any ongoing rehabilitation as an outpatient while the majority of the arthroplasty group required further inpatient rehabilitation. [ABSTRACT FROM AUTHOR]