Predictors of ambulation in the immediate postoperative period of hip arthroplasty in older adults: a longitudinal study
Aged; Arthroplasty; Early Ambulation; Muscle Strength; Risk Factors.
BACKGROUND: Among the impairments that elderly individuals are subject to and that compromise their walking, femoral neck fractures, which are treated with hip arthroplasty, stand out. Several factors have been associated with physical-functional outcomes after hip arthroplasty; however, most studies have investigated delayed ambulation only in females or in patients without cognitive impairment. OBJECTIVES : determine whether age, cognitive status, body mass index (BMI), muscle strength and functional capacity are associated with ambulation in the immediate postoperative period of hip arthroplasty in older adults with femoral neck fractures, and if the assessment tools for these factors can predict early ambulation. METHODS: This prospective observational longitudinal study analyzed 62 older adults with femoral neck fractures who underwent hip arthroplasty at a tertiary referral hospital in Brazil between June 2021 and December 2022. Age, BMI, cognitive status (Mini-Mental State Examination - MMSE), functional capacity (modified Barthel index) and muscle strength (handgrip dynamometry) were assessed before surgery and ambulation capacity (≥10 steps) was evaluated up to three days after the procedure. Comparative analyses and logistic regression were performed. RESULTS: Younger age, greater muscle strength and better cognitive status and functional capacity were associated with immediate postoperative walking ability. In multiple regression, better cognitive status and muscle strength remained predictors of early ambulation. The MMSE and handgrip dynamometry were accurate at predicting walking ability. CONCLUSION: Older adults with femoral neck fracture, greater grip strength and better cognitive status have a higher chance of walking by the third day after hip arthroplasty. The MMSE and handgrip dynamometry can be used in preoperative screening to assess the risk of unsuccessful early ambulation and devise effective interventions.