Journal CME, May 2023: Predictors of post-hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture-Journal CME, May 2023: Predictors of post-hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture

Journal CME, May 2023: Predictors of post-hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture

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This study aimed to determine if femoral morphology (specifically neck-shaft angle [NSA] deviation and leg length discrepancy [LLD]) and knee extension range of motion (KE-ROM) limitation are independent predictors of post-hip fracture knee pain (PHFKP) in older adults hospitalized after intertrochanteric femoral fracture surgery. The study was a retrospective chart review which included 103 patients, among whom 36 (35%) developed PHFKP.<br /><br />Main findings indicated that patients in the PHFKP group had a longer hospital stay, higher body mass index (BMI), greater KE-ROM limitation, and more varus NSA compared to the non-PHFKP group. Logistic regression analysis identified NSA discrepancy (varus deviation) and KE-ROM limitation as significant independent predictors of PHFKP with odds ratios of 0.85 and 1.18, respectively. BMI, although higher in the PHFKP group, was not an independent predictor.<br /><br />Receiver operating characteristic (ROC) analysis revealed moderate accuracy of NSA discrepancy and KE-ROM limitation in predicting PHFKP, with cutoff values of 9.6 degrees for NSA and 7.5 degrees for KE-ROM limitation. These metrics demonstrated 66.7% sensitivity and 85.1% specificity for NSA, and 50% sensitivity and 83.6% specificity for KE-ROM limitation.<br /><br />The study concludes that varus NSA and KE-ROM limitation are useful predictors for PHFKP, suggesting that monitoring these parameters could help in early identification and management of patients at risk of developing knee pain post-hip fracture. This could potentially improve rehabilitation outcomes and reduce hospitalization duration.<br /><br />However, the study has limitations such as not including muscle strength assessment, slightly low sensitivity in cutoffs, and lack of radiographic evaluation for preexisting knee osteoarthritis. Future research should address these aspects to better understand and manage PHFKP.

Keywords

femoral morphology

neck-shaft angle

leg length discrepancy

knee extension range of motion

post-hip fracture knee pain

intertrochanteric femoral fracture

logistic regression analysis

receiver operating characteristic

rehabilitation outcomes

predictors