The Association Between Sarcopenia and Functional Outcomes After Bipolar Hemiarthroplasty in Elderly Patients with Displaced Femoral Neck Fracture. Structural Equation Modeling.

Authors

• Sanzhar Artykbay, Chulalongkorn UniversityFollow
• Stephen J. Kerr, Chulalongkorn UniversityFollow
• Saran Tantavisut, Chulalongkorn UniversityFollow

Abstract

Background: Sarcopenia is an underrecognized condition that may impair recovery after hip fracture surgery in older adults.

Objectives: This study aimed to assess the impact of sarcopenia on functional outcomes and hip muscle strength in elderly individuals with femoral neck fractures while accounting for other potential confounding factors through a structural equation model (SEM).

Methods: Between January 2023 and October 2024, a prospective cohort study at a tertiary university hospital enrolled patients aged 60 and older undergoing bipolar hemiarthroplasty for displaced femoral neck fractures. Functional recovery was evaluated at 3-months follow-up using the Barthel Index (BI), Short Physical Performance Battery (SPPB), Harris Hip Score (HHS), and hip muscle strength. Sarcopenia was diagnosed per the 2019 Asian Working Group criteria, alongside assessments of osteoporosis and nutrition. SEM analyzed the impact of sarcopenia on recovery while adjusting for key factors.

Results: Sixty patients (mean age: 81 ± 8.4 years; 76.7% female) were included, with 15 (25%) identified as sarcopenic. Sarcopenia and malnutrition had significant negative effects on BI, HHS, and SPPB scores. Longer hospital stays were independently associated with lower HHS. SEM revealed indirect pathways linking age, BMI, and baseline functional status to outcomes through sarcopenia and malnutrition. Sarcopenia was significantly associated with reduced hip muscle strength, as measured by a latent variable (L1).

Conclusion: Sarcopenia and malnutrition are major contributors to impaired short-term functional recovery after bipolar hemiarthroplasty in elderly patients with femoral neck fractures. Both factors independently and synergistically affect physical performance, hip-specific function, and independence in daily activities. SEM highlighted the interrelationships between nutritional status, sarcopenia, and baseline function, emphasizing the importance of early detection and targeted interventions in postoperative care.

DOI

10.56808/2673-060X.5722

Recommended Citation

Artykbay, Sanzhar; Kerr, Stephen J.; and Tantavisut, Saran (2026) "The Association Between Sarcopenia and Functional Outcomes After Bipolar Hemiarthroplasty in Elderly Patients with Displaced Femoral Neck Fracture. Structural Equation Modeling.," Chulalongkorn Medical Journal: Vol. 70: Iss. 3, Article 3.
DOI: https://doi.org/10.56808/2673-060X.5722
Available at: https://digital.car.chula.ac.th/clmjournal/vol70/iss3/3