Weight-bearing impact after surgically treated proximal femur fracture in patients aged 65 years and older: systematic review

Abstract

The incidence of proximal femur fractures is increasing among older adults. Although surgical treatment is often required to restore pre-fracture functional status, the optimal postoperative weight-bearing strategy remains controversial. This systematic review aimed to evaluate the impact of early weight-bearing after surgically treated proximal femur fractures in patients aged 65 years and older. A systematic search of Medline (via Ovid and PubMed), Embase, Scopus, Google Scholar, and the grey literature was conducted in accordance with the PRISMA 2020 guidelines for studies published between 1 January 2003 and 7 June 2024. Studies written in English or French including patients aged 65 years and older and comparing postoperative weight-bearing strategies following surgical treatment of proximal femur fractures were eligible for inclusion. The methodological quality of the included studies was assessed using the ROBINS-I and RoB tools. Of the 695 studies identified, seven met the inclusion criteria. The available evidence addressed functional outcomes, length of hospital stay, mortality, medical complications, and orthopaedic complications. Overall, early weight-bearing was associated with lower mortality, shorter hospital stay, fewer medical complications, and improvements in some functional outcomes, without an apparent increase in orthopaedic complications. However, the available evidence is limited, predominantly observational, and subject to substantial heterogeneity; therefore, causality cannot be established.