title: Type of surgery is associated with pain and walking difficulties among older people with previous hip fracture.
abstract: OBJECTIVE
  The aim was to assess the level of lower body pain among people with previous femoral neck fracture, and whether the type of surgery was associated with pain and physical function a mean of 2 years after surgery.
  
  
  METHODS
  The study included 115 community-dwelling older adults aged 60 years and older with previous femoral neck fracture, and 31 reference subjects without previous lower limb injuries. A total of 30 patients had internal fixation surgery, 70 had hemiarthroplasty and 15 had total hip replacement. All patients had surgery in the same hospital and received typical inpatient rehabilitation. From 1.6 months to 7.5 years after the fracture, the patients underwent examination including clinical evaluation, measurements of pain in the lower body (visual analog scale), physical function (maximal walking speed, Timed Up & Go, Berg Balance Scale) and self-reported walking difficulties.
  
  
  RESULTS
  Hip fracture patients reported more pain (81 ± 88 mm) compared with the reference group (25 ± 39 mm, P = 0.004). Patients with internal fixation reported significantly more pain than the other study groups. Significantly more patients with internal fixation (53%) reported walking difficulties compared with patients who had hemiarthroplasty (29%, P = 0.028) or total hip replacement (13%, P = 0.018). No significant difference was observed in performance-based physical function between the fracture groups, but participants in the reference group had better physical function than any of the fracture groups.
  
  
  CONCLUSIONS
  Hip fracture patients treated with internal fixation experienced more pain and walking difficulties than the hemiarthroplasty and total hip replacement groups. Different types of surgical fixation might require different rehabilitation and pain management strategies after hip fracture. Geriatr Gerontol Int 2015; ●●: ●●-●●.
authors.affiliation: Research and Development, Mikkeli University of Applied Sciences, Mikkeli, Finland.|Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Anu
authors.initials: A
authors.lastname: Salpakoski
authors.affiliation: Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland.
authors.forename: Mauri
authors.initials: M
authors.lastname: Kallinen
authors.affiliation: Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kiviranta
authors.affiliation: Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland.|Institute of Health Sciences, University of Oulu, Oulu, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Alen
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Erja
authors.initials: E
authors.lastname: Portegijs
authors.affiliation: Service Line of General Practice and Geriatrics, Hatanpää Hospital, Tampere, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Jämsen
authors.affiliation: Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Jyväskylä, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Ylinen
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Rantanen
authors.affiliation: Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Sarianna
authors.initials: S
authors.lastname: Sipilä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D005387:Finland; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D059352:Musculoskeletal Pain / Q000175:diagnosis* / Q000534:rehabilitation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000534:rehabilitation; D011379:Prognosis; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016138:Walking / Q000502:physiology
keywords: balance; hip fracture; pain; rehabilitation; walking