Gait changes after intramedullary nailing versus total hip arthroplasty for hip fractures in older adults

Abstract

This study aimed to investigate potential differences in spatiotemporal gait parameters and clinical outcomes between older adults undergoing intramedullary nailing (IN) and those undergoing total hip arthroplasty (THA) for unilateral hip fractures. A secondary objective was to identify predictors of postoperative falls in older adults following surgical treatment for hip fractures. We conducted a prospective study involving 42 community-dwelling older adults, assessed 6 months post-surgery. Of these participants, 21 (14 females, 7 males; mean age 76.0 ± 8.6 years) underwent IN, while the remaining 21 (10 females, 11 males; mean age 75.3 ± 7.7 years) received THA. Primary outcomes included gait speed and step width for both treatment groups, while secondary outcomes included the incidence of postoperative falls and additional clinical and spatiotemporal gait parameters. The mean gait speed was 73.5 ± 26.8 cm/s for the IN group and 79.7 ± 27.5 cm/s for the THA group (P = .46). Step width was significantly lower in the IN group (15.7 ± 2.7 cm) compared to the THA group (17.9 ± 3.3 cm; P < .05, effect size = 0.7). Postoperative falls were reported by 13 patients (31%) overall, with no significant differences between the 2 treatment groups. Multivariate logistic regression analysis identified an increased step width (≥18 cm, OR = 5.24; 95% CI: 0.98–27.97; χ² = 1.66, P = .05) as a potential independent risk factor for postoperative falls, while a higher modified Harris Hip score (≥80 points) was an independent protective factor (OR = 0.18; 95% CI: 0.03–0.97; χ² = ‐1.69; P = .04). The area under the curve was 0.889 (95% CI: 0.809–0.989; P < .001). The optimal cutoff point for the highest sensitivity (100%) and specificity (65.5%) was 0.217. Model accuracy for predicting postoperative falls was 76.2%. In conclusion, both IN and THA resulted in favorable clinical outcomes and comparable gait speeds following hip fracture surgery in older adults, though step width was greater in the THA group. Despite the high overall incidence of postoperative falls, no significant differences in fall occurrence were observed between the 2 treatment groups. Abbreviations: BMI = body mass index, GDS = geriatric depression scale, IN = intramedullary nailing, mHHS = modified Harris Hip score, MMSE = minimental state examination, THA = total hip arthroplasty.