Walking Independence Within 14 Days After Surgery in Patients With Proximal Femoral Fractures Can Be Predicted From Weight Bearing Ratio.

Abstract

Background and purpose: Early prediction of walking independence after proximal femoral fracture (PFF) surgery is essential for discharge planning and rehabilitation. However, many existing models require multiple assessments, limiting feasibility in the early postoperative period. This study investigated whether the weight-bearing ratio (WBR), measured on postoperative days 3, 5, and 7, predicts walking independence within 14 days after surgery and compared predictive accuracy across timepoints.

Methods: This retrospective cohort study included patients who underwent surgical treatment for PFF at a single acute-care hospital between December 2021 and December 2023. Fifty participants who were able to walk independently on flat ground before injury were analyzed. The WBR was measured on postoperative days 3, 5, and 7 using a floor scale during supported standing. Walking independence at postoperative day 14 was defined as a functional independence measure gait score ≥ 6. Receiver operating characteristic curve analysis identified optimal cutoff values and evaluated predictive accuracy. Associations between WBR and clinical factors were examined using correlation and multiple regression analyses.

Results and discussion: The optimal WBR cutoff values for predicting walking independence were 60% on postoperative day 3, 70% on day 5, and 76% on day 7. The area under the curve was 0.91 on postoperative days 3 and 5 and 0.95 on day 7, with no significant differences between timepoints. On postoperative day 3, WBR was independently associated with pain during weight bearing and lower limb muscle endurance, whereas balance ability was significant on days 5 and 7. These findings suggest that early postoperative WBR reflects changes in pain, strength, and balance influencing walking recovery.

Conclusions: The WBR measured as early as postoperative day 3 predicts walking independence within 14 days with accuracy comparable to later measurements. Early WBR assessment provides a simple, low-cost indicator that may support identification of participants at risk for delayed recovery and guide rehabilitation and discharge planning after PFF surgery.