Mobility after proximal femur fracture - comparison of two surgical procedures: prosthetic replacement vs osteosynthesis

Introduction:

Proximal femur fractures in older adults are common and often lead to lasting mobility impairments. Evidence comparing mobility outcomes between different surgical procedures with early full weight-bearing, such as osteosynthesis and prosthetic replacement, is limited. The aim of this study is to examine differences in mobility outcomes between both procedures to inform future treatment decisions.

Method:

Patients aged 65 years and older, treated for proximal femur fracture at the Trauma Surgery Unit at the Klinikum Oldenburg in Germany were enrolled. Besides others, the De Morton Mobility Index (DEMMI) and the Barthel Index were assessed postoperative and before discharge. ANOVA was used to compare the groups (osteosynthesis, prosthesic replacement) over time (after surgery, before discharge).

Results:

Overall, 68 patients were included (age: 80.6±8.1 years; BMI: 24.2±3.8 kg/m²), 30 patients were treated using osteosynthesis, 38 using prosthetic replacement. The raw DEMMI score of both groups improved significantly over time (p<0.001), the groups showed a significant difference (p = 0.008), but no interaction effect was found (p = 0.556). DEMMI score increased from 2.3±2.3 shortly after surgery to 8.7±2.5 before discharge in the osteosynthesis patients, and from 2.8±2.3 to 9.8±2.2 in the prosthesic replacement group. Regarding the Barthel-Index, a significant effect for the factor time (p<0.001), but no significant group (p=0.134) or interaction effect (p=0.630) was calculated. Barthel Index increased from 31.1±14.6 points shortly after surgery to 63.9 ± 15.0 points before discharge in the osteosynthesis group and from 35.0±16.2 to 70.0±16.4 points in the prosthesis group.

Discussion:

Both groups showed similar improvements in postoperative mobility and self-care ability. The surgical method may not be the decisive factor for remobilization - approval of full weight-bearing and postoperative mobilisation appears essential.