Long-term effect of lower limb fractures A national register-based cohort study with a mean of 16.7 years follow-up

Aim

Information on patient-reported recovery from lower limb fractures includes limited information with >10 years follow-up. The aim was to investigate the long-term effect of lower limb fractures on the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Outcome Score (FAOS) five subscales.

Methods

Study design was a national register-based cohort study. A representative national sample of 26,877 citizens were invited to participate by completing the HOOS, KOOS or FAOS. Individual information on fractures to the foot/ankle, knee and hip as well as date/year of diagnoses was derived from the Danish National Patient Register.

Results

HOOS, KOOS or FAOS were completed by 7,850 citizens. 489 (2 %) patients were registered with a lower limb fracture. The mean follow-up time from fracture to survey was 16.7 years, ranging from 0 to 45 years. The mean age of participants with a lower extremity fracture was 62.9 years and 61 % were women, compared to patients without a lower extremity fracture with a mean age of 60.2 years and 54 % were women.

The HOOS/KOOS/FAOS mean differences between patients with and without a lower limb fracture were pain:4.4 (95 % CI -6.1– -2.7); symptoms:4.2 (95 % CI -5.9– -2.6); ADL:3.8 (95 % CI -5.4– -2.1); sport/rec:8.2 (95 % CI -10.9– -5.5); and QOL:6.5 (95 % CI -8.7– -4.2). Further subgroups analysis comparing hip-related fractures to the HOOS, knee-related fractures to the KOOS and foot/ankle-related fractures to the FAOS showed comparable results.

Conclusion

We showed that long-term patient-perceived complaints following lower limb fractures are common even decades after treatment. Most complaints were observed in high performance activities such as running, jumping and kneeling as well as QOL. More research is needed to address questions regarding causality.