By: 25 October 2011

Antonella Barone, MD, et al.
Archives of Physical Medicine and Rehabilitation. September 2009. Vol. 90. No. 9. Pp. 1495-1498.

This article reports on efforts to use an immediate weight-bearing early ambulation (IWB-EA) program after surgery to repair a hip fracture.

Surgeons at the Genoa Galliera Hospital in Liguria, Italy studied a group of older adults with hip fracture. Everyone in the study was 70 years old or older and had surgery to stabilize a proximal femur fracture. Before the hip fracture occurred, these patients were all still walking independently without assistance from a walker, crutches, or person assisting them.

The type of surgery performed depended on the location and severity of the fracture. Some patients only needed to have the bone repaired with metal plates and screws or a long intramedullary pin. Others had to have a partial or complete hip replacement.

A physical therapist supervised a daily rehab program, and each patient was instructed by the therapist to put as much weight on the involved leg as was comfortable or tolerable. A walker was used for support and stability and the distance walked was increased daily. By the fourth day, patients were started on stairs and progressed to crutches when possible.

The therapists and nurses charted how soon after surgery the patients put weight on the leg. When the patient could walk forward at least 15 feet, they were credited with having successfully ambulated.

Those patients who could put weight on the leg and walk within 48 hours of the surgery were labeled compliant or adherent to the immediate weight-bearing early ambulation) protocol. Anyone who did not achieve this weight-bearing status was considered nonweight-bearing (NWB).

Analysis of the data showed that 78% of the patients could weight-bear and ambulate within 48 hours (most achieved this in the first 24 hours). About half of the remaining 22% eventually made the goal of weight-bearing and ambulation before being discharged from the hospital. The authors found that it wasn’t their age or cognitive function that made a difference in weight-bearing outcomes. It was the day of the week the surgery was done. Patients who had surgery on Friday or the day before a holiday were much more likely to end up in the nonweight-bearing group.

Reduced numbers of physical therapists and nurses and the absence of physicians in the hospitals on weekends and holidays appear to make a difference in how patients progress after surgical stabilization of hip fractures.