Recovery of pre-injury functional state following operative treatment of displaced femoral neck fractures; a prospective cohort study

Sephenia Raduma Ochieng, John Kingori, Kirsteen Ondiko Awori, John Ernest Oluoch Ating'a, Sephenia Raduma Ochieng, John Kingori, Kirsteen Ondiko Awori, John Ernest Oluoch Ating'a

Abstract

Background: The incidence of fracture neck of femur (FNF) has been projected to increase significantly. This study sought to determine the recovery of preinjury functional state following operative treatment of displaced FNF.

Materials and methods: A six-month prospective cohort study was conducted at Kenyatta National Hospital (KNH) and PCEA Kikuyu Mission Hospital (KMH) between November 2008 and May 2009. Sixty patients were enrolled using a pre-tested questionnaire. The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores were used. The functional outcome measures included pain, stiffness and activities of daily living (ADL). Stratification and subgroup analysis were done especially based on age. Student's t-test and χ 2 test were used for comparison between variables as appropriate with a p < 0.05 being considered statistically significant.

Results: Majority of the patients recruited were males (68%) with a mean age of 51.6 years. Eighty eight percent of the patients had a mean negative early functional outcome score. Hemiarthroplasty (HA) and Total Hip Arthroplasty (THA) had comparable early post-operative functional outcome while Osteosynthesis (OS) had a poorer ADL outcome. Prolonged hospital stay was associated with a poor ADL outcome (p = 0.020). Use of the antero-lateral approach to the hip was associated with a better ADL outcome in patients older than 50 years (p = 0.007).

Conclusions: At three months post-operatively, most patients have not fully recovered their pre-injury level of function and independence. Both HA and THA are associated with better early functional outcome compared to OS.

Study type: Original research.

Keywords: ADL, Activities of Daily Living; ASA, American Society of Anesthesiologists; Arthroplasty; FNF, Femoral Neck Fracture/ Fracture Neck of Femur; FNFs, Femoral Neck Fractures; Fracture neck femur; Functional outcome; HA, Hemiarthroplasty; Hip fracture; KMH, PCEA Kikuyu Mission Hospital; KNH, Kenyatta National Hospital; LOS, Length of Hospital Stay; OS, Osteosynthesis (Internal fixation); Osteosynthesis; RTI, Road Traffic Injuries; SPSS, Statistical Package for the Social Sciences; THA/R, Total Hip Arthroplasty/ Replacement; UON, University of Nairobi; WOMAC, Western Ontario and MacMaster Universities Osteoarthritis Index.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
Changes between pre-injury and post-operative WOMAC scores (n = 60).

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