Association of cognitive status with mobility and functioning after femoral neck fracture surgery in elderly patients: differences between hemiarthroplasty and internal fixation

Background: Comparison of outcomes betweentwo different operative treatments of femoralneck fracture – hemiarthroplasty (HA) and internal fixation (IF) – remains an open issue. Weperformed new analyses of data from a previously published study with the aim of investigating the influence of cognitive problems on mobility and functioning after such surgery and comparing it between groups treated with HA and IF. Methods:Sixty-six elderly patients were consecutively enrolled in a prospective non-randomised study. The two groups (HA and IF, each comprising 33 patients) were balanced regarding age, gender and activity before injury. Data were gathered on their walking ability (categorised, measured via walking distance, and assessed using Walking Ability Index – WAI), cognitive status (assessed using Mini Mental State Examination – MMSE) and independence in activities of daily living (categorised, and assessed using Functional Independence Measure – FIM). Results: The association with MMSE score on admission was higher in the IF group than in the HA group for all the analysed outcome measures, i.e., walking distance at discharge, ability to walk unassisted (with walking aids) at discharge, ability to walk outdoors after three months, inde -pendence in activities of daily living after three months, improvement in motor FIM subscore after three months and WAI score at discharge. Conclusions: Presence of cognitive problems adversely affects walking ability and functioning mainly in patients operatively treated with IF after femoral neck fracture, and not (or to a much lesser extent) in patients treated with HA. It is recommended to take this into account during surgical decision-making.