Data_Sheet_1_Influence of Timing of Postoperative Weight-Bearing on Implant Failure Rate Among Older Patients With Intertrochanteric Hip Fractures: A Propensity Score Matching Cohort Study.docx

Introduction: The purpose of this study was to determine whether immediate weight-bearing as tolerated increased the risk of implant failure and decreased functional outcomes compared with restricted weight-bearing.
Methods: From January 2010 to December 2018, 1,125 consecutive patients (≥65 years) with intertrochanteric fractures were identified. Of them, 130 patients were excluded, resulting in 995 patients in final cohort (563 receiving immediate weight-bearing and 432 receiving restricted weight-bearing). Propensity score (PS) matching yielded 403 patient pairs. Primary outcome was implant failure at 12 months. Secondary outcomes were implant failure at 3 months, functional outcomes at 12 months, and time to full weight-bearing.
Results: Among 806 patients who were matched by PS, the mean age was 77.8 years (SD, 7.6), and 603 patients (74.8%) were women. After matching, there was no significant difference between immediate (10.0% [39/389]) and restricted (9.1%, [35/385]) weight-bearing for implant failure at 12 months (absolute risk difference, 0.93% [95% CI, −3.26 to 5.13%]; RR, 1.11 [95% CI, 0.69 to 1.80]; p = 0.66). Additionally, no significant difference was seen for implant failure at 3 months and functional outcomes at 12 months. Patients with immediate weight-bearing had shorter time to full weight-bearing (mean [SD], 87.6 days [7.5] vs. 121.3 days [11.0]; mean difference, −33.7 [95% CI, −35.0 to −32.3]; p < 0.001).
Conclusions: Among older patients with intertrochanteric fractures, receipt of immediate weight-bearing as tolerated did not increase risks of implant failure or worsen functional outcomes compared with receipt of restricted weight-bearing. However, patients receiving immediate weight-bearing had a shorter time to full weight-bearing.

研究背景：本研究旨在明确，与限制性负重方案相比，即刻可耐受负重是否会增加植入物失败风险并降低功能预后。
研究方法：2010年1月至2018年12月期间，共纳入1125例年龄≥65岁的连续性转子间骨折（intertrochanteric fractures）患者。其中130例被排除，最终研究队列纳入995例患者，563例接受即刻可耐受负重方案，432例接受限制性负重方案。通过倾向得分（Propensity Score, PS）匹配，最终得到403对匹配患者。本研究的主要结局指标为术后12个月时的植入物失败率；次要结局指标包括术后3个月时的植入物失败率、术后12个月时的功能预后，以及达到完全负重的时间。
研究结果：经PS匹配的806例患者中，平均年龄为77.8岁（标准差（Standard Deviation, SD）=7.6），其中女性603例，占比74.8%。匹配后，即刻可耐受负重组（10.0% [39/389]）与限制性负重组（9.1% [35/385]）在术后12个月的植入物失败率无显著统计学差异（绝对风险差0.93%，95%置信区间（Confidence Interval, CI）：-3.26%~5.13%；相对危险度（Relative Risk, RR）=1.11，95%CI：0.69~1.80；p=0.66）。此外，两组在术后3个月植入物失败率及术后12个月功能预后方面均无显著统计学差异。即刻可耐受负重组患者达到完全负重的时间更短：平均（SD）为87.6天（SD=7.5） vs 121.3天（SD=11.0）；平均差异为-33.7天（95%CI：-35.0~-32.3；p<0.001）。
研究结论：对于老年转子间骨折患者，与限制性负重方案相比，实施即刻可耐受负重并未增加植入物失败风险或恶化功能预后。但接受即刻可耐受负重的患者达到完全负重的时间更短。