Fixation Versus Replacement in XXXX : Does Functional Outcome and Independence in Self-Care Differ?

@entity1 @entity173
INTRODUCTION: Although there is evidence of improved functional outcomes with our "integrated care pathway" for @entity173 , we do not know if there is a significant difference in functional recovery of activities of daily living and attainment of independence in self-care between @entity1 who underwent fixation and those treated with arthroplasty. OBJECTIVE: To determine whether such a difference exists in surgically fixed @entity173 . MATERIALS AND METHODS: @entity1 with @entity173 treated surgically were divided into group A (internal fixation, n = 213) and group B (arthroplasty, n = 199). Demographic data, Charlson comorbidity index (CCI) score, time to surgery, and length of stay were recorded. Inpatient complications and mortality rates were also documented. Modified Barthel Index (MBI) scores were recorded for the following intervals: prefall, discharge, 6-month, and at 1-year follow-up. RESULTS: The mean age (A: 80 years and B: 81years), CCI (A: 5.41 and B: 5.43), and length of stay (A: 13.6 days and B: 15.2 days) were not significantly different. However, there was a significant difference (P < .05) in time to surgery (A: 102.2 hours and B: 86.6 hours). Complication rates were about 6% in both groups (A = 6.57%: urinary infections = 13, wound infections = 1 and B = 6.03%: urinary infections = 10, wound infections = 1, pressure ulcer = 1). The preinjury MBI scores were significantly different (P < .05; A: 91.65 and B: 88.19), however, there was no significant difference in scores measured at discharge (A: 60.79 and B: 59.39), 6 months (A: 77.65 and B: 77.47) and 1 year (A: 80.71 and B: 83.03). @entity1 who underwent surgery for @entity173 had overall recovered 90.9% of their preinjury function (overall MBI at 1 year: 81.83). CONCLUSION: The MBI scores reflect the extent of attainment of independence in self-care, and actual functional recovery is gauged from the percentage of recovery of preinjury function at 1 year postsurgery. We conclude that the type of surgery may not be a significant factor in determining independence in self-care although @entity1 who had arthroplasty had recovered more function at 1 year postsurgery than those who underwent fixation (percentage recovery of preinjury function-A: 88.1% and B: 94.1%).
