Factors influencing and predicting the trajectory of care dependence among older hip fracture patients after total hip arthroplasty: a longitudinal study

Abstract

Objective

This study aimed to describe the development trajectory of care dependence in elderly total hip arthroplasty patients over a one-year survival period, identify heterogeneous care dependence trajectories, analyze the factors influencing the different underlying characteristics, further explore their predictors, and construct nomograms for prediction.

Methods

This study was conducted in three tertiary hospitals, 210 elderly patients over 60 who underwent total hip arthroplasty completed a one-year follow-up. Clinical evaluation and data collection were performed at surgical hospitalization and 1,6 and 12 months postoperatively. Latent growth mixed models(LGMM) were performed to explore the trajectories of change in patients' care dependence and identify heterogeneous trajectories. The multivariate logistic regression model was used to determine their predictors, and a nomogram was further constructed based on the predictors.

Results

The LGMM identified four classes of care dependency trajectories:“high dependency”,“dependency rising”,“dependency relief”,and“dependency decreasing”. The first two were referred to as “high-risk care dependency group” and the latter two were”low-risk care dependency group”. Regression analyses revealed age, education levels,comorbidity, postoperative complications, and whether to use an analgesic pump were independent predictors of heterogeneous care dependence trajectories, and a nomogram was constructed based on these predictors.

Conclusions

Older total hip arthroplasty patients have different heterogeneous trajectories of care dependency during one-year postoperative survival. Therefore, early assessment to predict the occurrence of heterogeneous trajectories of care dependency is important to improve the prognosis of elderly total hip arthroplasty patients and to help them return to independent living as soon as possible.