Tag: hip surgery

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Progressive Exercise Programme Improves Outcomes after Hip Surgery

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Carers help an old man to walk
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A study published in the Journal of the American Geriatrics Society shows that a 12-month home-based supervised exercise programme can help to improve physical performance and functioning after patients undergo hip fracture surgery.

Hip fracture is a major health problem among older people, often resulting in long-term, sometimes persistent, functional impairments such as poor mobility and reduced independence in daily activities. Sedentary behaviour and low level of physical activity are also common among patients recovering from surgical repair of a hip fracture.

Standard care post-discharge care does not seem to meet the requirements of effective rehabilitation, as many patients with hip fractures do not reach their pre-fracture level of functioning. Growing evidence shows that multidisciplinary and well-coordinated rehabilitation started at the hospital and continued after discharge enhances the recovery of patients with hip fractures. Multicomponent rehabilitation in particular, which includes individualised and progressive resistance training, has improved functioning and mobility and decreased dependency in everyday activities. Longer lasting exercise programs of 6 to 12 months duration have reduced or reversed incident disability after hip fractures.

For the study, 121 patients aged 60 years and older were randomised to either an exercise group or a usual care group as a control. Home-based exercise sessions were delivered by physiotherapists twice a week and included strength, balance, mobility, and functional components as well as brief counselling on physical activity and nutrition.

Compared with patients in the usual care group, patients in the exercise group saw more improvements over the course of a year in their physical performance, their handgrip strength, and their ability to complete certain activities of daily living.

“It is worthwhile to invest in rehabilitation exercise for older people after hip fracture. Better functioning benefits the individual and also society,” said lead author Paula K. Soukkio, MSc, of the South Karelia Social and Health Care District (Eksote), in Finland.

Source: Wiley

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Equivalent Hip Surgery Outcomes for Spinal vs General Anaesthesia

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Photo by Piron Guillaume on Unsplash

Research comparing general versus spinal anaesthesia for hip fracture surgery shows similar outcomes for patients, challenging the common thinking that patients receiving spinal anaesthesia fare better. 

Led by researchers from the Perelman School of Medicine at the University of Pennsylvania, the study was published in the New England Journal of Medicine and presented at Anesthesiology 2021, the annual meeting of the American Society of Anesthesiologists (ASA).

“Available evidence has not definitively addressed the question of whether spinal anaesthesia is safer than general anaesthesia for hip fracture surgery, an important question to clinicians, patients, and families. Our study argues that, in many cases, either form of anaesthesia appears to be safe,” said lead investigator Mark D. Neuman, MD, MSc, an associate professor of Anesthesiology and Critical Care. “This is important because it suggests that choices can be guided by patient preference rather than anticipated differences in outcomes in many cases.”

While most of the 250 000 annual hip fracture patients in the US undergo general anaesthesia, spinal anaesthesia increased by 50% between 2007 and 2017, while in the United Kingdom and other countries, spinal anaesthesia is used in over 50% of hip fracture cases. [PDF]

Most recent comparisons of general anaesthesia versus spinal anaesthesia come from non-randomised studies, some indicating fewer cognitive and medical complications with spinal. Some patients may choose spinal anaesthesia for lower complications, while those choosing general may have a fear of spinal injection or insufficient anaesthesia. 

The study enrolled 1600 patients, all at least 50 years old, who had broken a hip. Among older populations, hip fractures are particularly worrisome as they can lead to a loss of mobility, linked to a doubling or even tripling the risk of near-term death. The patients were randomised into two groups, a major advantage for the study.

The researchers combined subsequent patient death rates and whether they regained the ability to walk, even with a walker. By 60 days post-surgery, 18.5% of patients assigned to spinal anaesthesia had either died or become newly unable to walk versus 18% of patients who received general anaesthesia. Mortality at this point was 3.9% of patients who received spinal anaesthesia died versus 4.1% who got general anaesthesia.

Additionally, to examine how the different forms of anaesthesia factored into potential cognitive complications, the researchers also examined post-operative delirium. Delirium was experienced in 21% of spinal anaesthesia patients versus 20% for general anaesthesia.

“What our study offers is reassurance that general anaesthesia can represent a safe option for hip fracture surgery for many patients,” said Prof Neuman. “This is information that patients, families, and clinicians can use together to make the right choice for each patient’s personalised care.”

Source: Perelman School of Medicine at the University of Pennsylvania