Osteologie 2019; 28(03): 183-191
DOI: 10.1055/a-0962-2043
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Musculoskeletal Rehabilitation after Hip Fracture: A Review

Muskuloskelettale Rehabilitation nach Hüftfrakturen: eine Übersichtsarbeit
Michael Pfeifer
1   Institute of Clinical Osteology Gustav Pommer and Clinic „DER FÜRSTENHOF“ Bad Pyrmont, Germany
,
Yannis Dionyssiotis
2   Department of Metabolic Bone Disease, Physical Medicine and Rheumatology, Rehabilitation Unit, University of Patras, Patras, Greece
› Author Affiliations
Further Information

Publication History

25 June 2019

04 July 2019

Publication Date:
12 September 2019 (online)

Abstract

With increasing longevity, hip fractures become more and more a serious burden not only for societies in developed civilization, but also for emerging countries. According to world-wide projections 1.5 million people are affected each year. Although a lot of research has been performed over the last decade, there is still a lack of standardized and evidence-based approaches for prevention, treatment, and rehabilitation of this worst complication of osteoporosis.

Therefore, the evidence base for this article was synthesized in accordance with SIGN methodology. Databases searched include Medline, Embase, Cinahl and the Cochrane Library between March 1999 and March 2019. The following terms are used: osteoporosis, hip fracture, rehabilitation, falls, muscle strength, nutrition, exercise, balance, sway, and hip protectors. Moreover, reference lists from included studies were checked and author`s names were searched for additional studies.

Possibly, the best approach to rehabilitation after hip fracture is a multi-disciplinary team co-ordinating medical, social, educational and vocational measure for training or retraining the individual to the highest possible level of function. In order to prevent thromboembolism low-dose anti-coagulation therapy (e. g. fondaparinux, rivaroxaban) may be used for approximately two weeks after surgery. This should be accompanied by a daily nutritional intake of at least 20 g protein, 1200 mg of elemental calcium and 800 I. U. of vitamin D, whereas in severe vitamin D insufficiencies recommendations may be certainly higher.

After surgical repair of the hip fracture, an anti-resorptive medication may be started. While balance training and performing of Tai Chi has been shown to reduce fall risk and thereby also decrease hip fracture risk, the use of hip protectors is still under evaluation and cannot be generally advocated.

Zusammenfassung

Mit steigender Lebenserwartung wird die damit einhergehende Zunahme von Hüftfrakturen nicht nur in den hoch zivilisierten Ländern, sondern auch in den Entwicklungsländern zu einer ernsthaften Herausforderung für die jeweiligen Gesundheitssysteme. Nach aktuellen Schätzungen erleiden weltweit betrachtet 1,5 Millionen Patienten pro Jahr eine Hüftfraktur. Trotz vielfältiger Forschungsbemühungen in der letzten Dekade fehlen immer noch standardisierte und wissenschaftlich überprüfte Ansätze zur Prävention, Behandlung und Rehabilitation dieser schlimmsten Ausprägung der Osteoporose.

Deshalb versucht dieser Artikel den derzeitigen Stand des Wissens in Übereinstimmung mit der vorgegebenen Methodik der „SIGN“-Kriterien zusammenzufassen. Hierzu wurden die zwischen März 1999 und März 2019 erschienenen und in mehreren Datenbanken erfassten Veröffentlichungen herangezogen. Entsprechend Suchbegriffen wie Osteoporose, Hüftfrakturen, Rehabilitation, Muskelkraft, Ernährung, Bewegungstherapie, Standgleichgewicht und Hüftprotektoren wurden in Datenbanken wie Medline, Embase, Cinahl und der Cochrane-Bibliothek nach entsprechenden Veröffentlichungen gesucht.

Möglicherweise erfordert der beste Ansatz zur Rehabilitation nach Hüftfrakturen ein interdisziplinäres Team, das die medizinischen, sozialen, sowie berufs- und wissensbezogenen Bedürfnisse der Patienten koordiniert. Nur dann kann es gelingen, ein möglichst hohes Niveau der Funktionalität im individuellen Fall zu erreichen. Zur Vermeidung postoperativer Embolien kann eine medikamentöse postoperative Behandlung zur Hemmung der Blutgerinnung mit beispielsweise Fondaparinux oder Rivaroxaban hilfreich sein. Dies sollte begleitet werden mit der täglichen Gabe von mindestens 20 g Eiweiß, 1200 mg Kalzium und 800 IE Vitamin D, wobei der weit verbreitete Vitamin-D-Mangel gegebenenfalls auch höhere Dosierungen von Vitamin D erforderlich machen kann.

Nach chirurgischer Therapie der Hüftfraktur könnte beim älteren Patienten die Einleitung einer anti-resorptiven Medikation zur Behandlung der höchstwahrscheinlich vorliegenden Osteoporose im Verlauf einer Anschlussheilbehandlung veranlasst werden.

Zum Training von Balance und Gleichgewicht kommt Tai-Chi in Frage, das in zahlreichen Studien neben einer Verminderung des Sturzrisikos zugleich das Risiko für Hüftfrakturen senken konnte. Die Hüftprotektoren hingegen können aufgrund neuester Studienergebnisse nicht mehr generell empfohlen werden.

 
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