AUTHOR=Jia Xiaoyang , Qiang Minfei , Zhang Kun , Han Qinghui , Wu Ying , Chen Yanxi 

TITLE=Influence of Timing of Postoperative Weight-Bearing on Implant Failure Rate Among Older Patients With Intertrochanteric Hip Fractures: A Propensity Score Matching Cohort Study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.795595

DOI=10.3389/fmed.2021.795595

ISSN=2296-858X

ABSTRACT=Introduction: The purpose was to determine whether immediate weight-bearing as tolerated increased the risk of implant failure and decreased functional outcomes compared with restricted weight-bearing.

Methods: From January 2010 to December 2018, 1125 consecutive patients (≥65 years) with intertrochanteric fractures were identified. Of them, 130 patients were excluded, resulting in 995 patients in final cohort (563 receiving immediate weight-bearing and 432 receiving restricted weight-bearing). Propensity score matching yielded 403 patient pairs. Primary outcome was implant failure at 12 months. Secondary outcomes were implant failure at 3 months, functional outcomes at 12 months, and time to full-weight-bearing.

Results: Among 806 patients who were matched by propensity score, the mean age was 77.8 years (SD, 7.6), and 603 patients (74.8%) were female. After matching, there was no significant difference between immediate (10.0% [39/389]) and restricted (9.1%, [35/385]) weight-bearing for implant failure at 12 months (absolute risk difference, 0.93% [95% CI, -3.26% to 5.13%]; RR, 1.11 [95% CI, 0.69 to 1.80]; P = 0.66). Additionally, no significant difference was seen for implant failure at 3 months and functional outcomes at 12 months. Patients with immediate weight-bearing had shorter time to full weight-bearing (mean [SD], 87.6 days [7.5] vs 121.3 days [11.0]; mean difference, -33.7 [95% CI, -35.0 to -32.3]; P < 0.001).

Conclusions: Among older patients with intertrochanteric fractures, receipt of immediate weight-bearing as tolerated did not increase risks of implant failure or worsen functional outcomes compared with receipt of restricted weight-bearing. However, patients receiving immediate weight-bearing had shorter time to full weight-bearing.