title: The influence of cognitive status on outcome and walking ability after hemiarthroplasty for femoral neck fracture: a prospective cohort study.
abstract: BACKGROUND
  Femoral neck fracture (FNF) is a devastating injury with serious medical and social consequences. One-third of these patients have some degree of impaired cognitive status. Despite this, a high proportion of hip fracture trials exclude patients with cognitive impairment (CI). We aimed to evaluate whether moderate to severe CI could predict walking ability, quality of life, functional outcome, reoperations and mortality in elderly patients with displaced FNF treated with hemiarthroplasty (HA).
  
  
  METHODS
  This cohort study included a consecutive series of 188 patients treated with HA for a displaced FNF. Patients were assessed for estimated preoperative and 1 year postoperatively with regard to walking ability, cognitive status, quality of life with EQ-5D and hip function with Harris hip score.
  
  
  RESULTS
  There were 188 patients who met the inclusion criteria. A total of 130 patients were in the control group, and 58 were in the CI group. At 1-year follow-up, 31 patients (24%) had died in the control group and 22 patients (38%) had died in the cognitive impaired group. This difference in reoperation and mortality rate was statistically significant (log-rank test, p = 0.016). The CI had a significantly higher incidence of being non-walker (28 vs. 4%, OR 9.2, p = 0.001). The EQ-5D was higher in the control group, while the Harris hip score was comparable in the two groups.
  
  
  CONCLUSIONS
  Moderate to severe CI was associated with a high incidence of non-walking ability, worse quality of life, high mortality and re-operation rate after femoral neck fractures treated with HA.
authors: Department of Surgical and Perioperative Science, Umeå University, 901 87, Umeå, Sweden.
authors: Sebastian
authors: S
authors: Mukka
authors: Department of Surgical and Perioperative Science, Umeå University, 901 87, Umeå, Sweden.
authors: Björn
authors: B
authors: Knutsson
authors: Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
authors: Ferid
authors: F
authors: Krupic
authors: Department of Surgical and Perioperative Science, Umeå University, 901 87, Umeå, Sweden. arkansam@hotmail.com.
authors: Arkan S
authors: AS
authors: Sayed-Noor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000150:complications*; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D062785:Hemiarthroplasty; D006801:Humans; D008297:Male; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012086:Reoperation; D012720:Severity of Illness Index; D015996:Survival Rate; D016138:Walking
keywords: Cognitive status; Femoral neck fracture; Hemiarthroplasty; Hip fracture; Outcome