Long-term patient reported outcomes after revision surgery for lower extremity nonunion: A retrospective cohort study.

Autor: Wagner RK; Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA. Electronic address: r.k.wagner@amsterdamumc.nl., Emmelot MP; Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands., Ly TV; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA., Harris MB; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA., Janssen SJ; Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands., Kloen P; Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 Nov; Vol. 55 (11), pp. 111779. Date of Electronic Publication: 2024 Aug 05.
DOI: 10.1016/j.injury.2024.111779
Abstrakt: Introduction: Ongoing lower extremity long-bone nonunion is a devastating condition and associated with substantial patient morbidity. There is limited evidence regarding physical and mental function after surgical management of lower extremity nonunions. The purpose of this study was to assess general physical and mental health and lower extremity specific physical function of patients that underwent surgery for a lower extremity long-bone nonunion.
Methods: One-hundred and twenty-four adult patients who underwent successful surgical management for a lower extremity long-bone nonunion between June 2002 and December 2021 were evaluated at an average follow-up of 8.6 years (interquartile range [IQR]: 4 - 12). General physical and mental health was assessed with the Short-Form 12 (SF-12) physical (PCS) and mental (MCS) component summaries, and lower extremity specific physical function with the Lower Extremity Functional Scale (LEFS). Multivariable linear regression was performed to identify variables that were independently associated with outcomes.
Results: The median LEFS was 50 (IQR: 37 - 63) and the median SF-12 PCS was 43 (IQR: 33 - 52), which are both lower than normative population scores (LEFS: 77 and PCS: 51, p < 0.0001). The median SF-12 MCS was 50, which was comparable to the normative population score of 51 (p < 0.0001). The number of previous surgeries before the index nonunion treatment (p = 0.018 and p = 0.041) and the number of revision surgeries after the index nonunion treatment (p = 0.022 and p = 0.041) were associated with lower LEFS and SF-12 PCS scores.
Conclusion: At an average of 8.6 years after lower extremity nonunion surgery that led to bone healing, patients continue to report lower general and lower extremity specific physical functioning compared to the normative population. The number of surgical attempts to obtain definitive healing was associated with compromised physical function scores. Mental health scores may return close to normative population scores. These results can be used to inform patients and guide treatment strategies and healthcare policies.
Competing Interests: Declaration of competing interest Robert K. Wagner received support from the Marti-Keuning Eckhardt Foundation (Amsterdam, the Netherlands), the Cultuurfonds (Amsterdam, the Netherlands), and the VSB Foundation (Utrecht, the Netherlands). Thuan V. Ly reports honoraria from the AO foundation and consulting fees from DePuy Synthes. For the remaining authors no conflicts of interest or sources of funding were declared.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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