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Archives of Orthopaedics

ISSN: 2692-8299

Original Research Open Access
Volume 6 | Issue 1 | DOI: https://doi.org/10.33696/Orthopaedics.6.037

Development and Internal Validation of a Clinical Prediction Model for 90-Day Walking Recovery Following Hip Hemiarthroplasty in Elderly Patients with Neck of Femur Fracture in Nigeria

Kehinde Adesola Alatishe1,*, Wakeel Olaide Lawal1, Taiwo Adedamola Alatishe2, Opeyemi Qozeem Asafa3, Michael Ebiyon Ugbeye1, Olatunji Sulaimon Olanrewaju4
  • 1Consultant Orthopaedic and Trauma Surgeon, Orthopaedic and Trauma department, National Orthopaedic Hospital, Lagos, Nigeria
  • 2Lecturer and Honorary Consultant Psychiatrist, Department of Psychiatry, LAUTECH and LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
  • 3Consultant General Surgeon, Faculty of Clinical Sciences, Osun State University, Osogbo, Osun State, Nigeria
  • 4Consultant Orthopaedic Surgeon, Department of Hospital services, Federal Ministry of Health, Abuja, Nigeria
+ Affiliations - Affiliations

Corresponding Author

Kehinde Adesola Alatishe, medistuff1@yahoo.com, Kehinde.alatishe@npmcn.edu.ng

Received Date: April 25, 2026

Accepted Date: June 23, 2026

Citation:

Alatishe KA , Lawal WO, Alatishe TA, Asafa OQ, Ugbeye ME, Olanrewaju OS. Development and Internal Validation of a Clinical Prediction Model for 90-Day Walking Recovery Following Hip Hemiarthroplasty in Elderly Patients with Neck of Femur Fracture in Nigeria. Arch Orthop. 2026;6(1):17–30.


Copyright: © 2026 Alatishe KA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Early mobilization following hip hemiarthroplasty for neck of femur (NOF) fractures is critical to reducing morbidity and mortality in elderly patients. Objective tools to predict short-term walking recovery are lacking.

Objectives: To develop and internally validate a clinical prediction model for 90-day postoperative walking recovery in elderly patients following hip hemiarthroplasty for neck of femur fracture in Nigeria.

Methods: This retrospective cohort study evaluated elderly patients with NOF fractures treated via hemiarthroplasty (January 2018–December 2022). Patients with unstable intertrochanteric or pathologic fractures, incomplete records, or 90-day mortality were excluded. Predictor variables were screened using univariable logistic regression. Factors with p<0.1 entered a multivariable model using backward stepwise elimination (p<0.05 for retention). Model performance was rigorously evaluated via discrimination (Area Under the ROC Curve [AUC]) and calibration (decile plot and Hosmer-Lemeshow test). Internal validation was performed via 1,000 bootstrap resamples and model utility was assessed using Decision Curve Analysis (DCA).

Results: Out of 286 screened cases, 162 patients were included. Four independent predictors of non-ambulatory outcomes were retained: residual limb weakness-LW (OR=8.68, p<0.001), cognitive impairment-Cog (OR=1.90, p=0.009), pre-injury walking status-pW (OR=1.30, p=0.042), and Charlson Comorbidity Index- CCI (OR=1.17, p=0.018). The model demonstrated strong discrimination (AUC=0.79; 95% CI: [0.70, 0.88]; p<0.001) and good calibration (Hosmer-Lemeshow p=0.664). DCA confirmed substantial clinical net benefit across a 15–75% threshold range. The final prognostic formula is: Log-Odds = 0.203 + (0.265 × pW) + (2.161 × LW) + (0.160 × CCI) + (0.644 × Cog).

Conclusion: This internally validated four-item clinical model effectively predicts 90-day walking recovery following hemiarthroplasty in Nigerian geriatric patients. It serves as a practical bedside tool to enhance preoperative risk stratification, counseling, and personalized postoperative rehabilitation care.

Keywords

Clinical prediction model, Ambulation, Hemiarthroplasty, Geriatrics, Neck of femur fracture, Multivariate analysis, Nigeria

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Development and Internal Validation of a Clinical Prediction Model for 90-Day Walking Recovery Following Hip Hemiarthroplasty in Elderly Patients with Neck of Femur Fracture in Nigeria

Early mobilization following hip hemiarthroplasty for neck of femur (NOF) fractures is critical to reducing morbidity and mortality in elderly patients. Objective tools to predict short-term walking recovery are lacking. To develop and internally validate a clinical prediction model for 90-day postoperative walking recovery in elderly patients following hip hemiarthroplasty for neck of femur fracture in Nigeria.

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