Factors associated with non-walking 4 months after hip fracture. A prospective study of 23,759 fractures

Introduction: Despite advances in new surgical techniques and improvements in medical care of the last decades a considerable number of patients will not regain their ability to walk after a hip fracture.

Aims: To further identify risk factors associated with non-walking 4-months after a hip fracture.

Material and methods: Register-based, longitudinal study with a 4-month follow-up. The collected data from the Swedish hip fracture registry, RIKSHÖFT, contained all hip fracture between 201301-01-2015-12-31 in Sweden. All patients older than 50 years with a non-pathological fracture and who were able to walk before the fracture were included. The association of sex, age, general health, dementia and type of discharge with complete loss of walking after a hip fracture were investigated using a multivariate analysis.

Results: Included were 23,759 patients. At the 4-month follow-up, 10% were unable to walk. Twenty-five per cent of patients with dementia lost their ability to walk compared to 7% of those with no cognitive dysfunction. Adjusted odds ratio (OR) for factors associated with loss of walking ability were; discharge to institutionalized care rather than their own home or a rehabilitation unit (OR=1.91; 95% CI=1.67-2.18), dementia (OR=1.80; 95% CI=1.57-2.06), male gender (OR=1.59; 95% CI=1.40-1.81) and ASA score grade III-V (OR=1.37; 95% CI=1.20-1.55) but not age (OR=1.01; 95% CI=1.00-1.02).

Conclusions: An important factor associated with a complete loss of walking ability after a hip fracture is the discharge to institutionalized care. This factor might be influenced either by favouring rehabilitation units or by improving the rehabilitation protocols.