Abstract
It has not yet been well established whether femoral shaft fracture malunion and malalignment
lead to the development of knee osteoarthritis.
This study has assessed a cohort of 62 patients after femoral shaft fracture at a
median follow-up of 22 years (range 18–28). The mean age of the patients at time of
follow-up was 42 years (33–80). Each patient was clinically examined for signs and
symptoms of osteoarthritis, radiographs were taken to assess malalignment and radiographic
osteoarthritic changes, and WOMAC and SF-36 (physical and mental) scores were measured.
Radiographic changes consistent with osteoarthritis were present in only 5 (8%) ipsilateral
and 3 (5%) contralateral knees. Clinical signs and symptoms of osteoarthritis were
present in only two (3%) ipsilateral knees. However, 16 patients (26%) exhibited mild
pain or stiffness in the ipsilateral knee, while only 4 patients (6%) had such findings
in their ipsilateral knee (OR 4; p = 0.004).
The median WOMAC score for knee pain was 3 (range 1–15; max 20), knee stiffness was
1 (0–8; max 8) and disability was 6 (0–55; max 68). The median SF-36 score for physical
function was 85 (range 0–100; max 100).
The mean coronal plane malunion was 5° (range −19° to 8°). There was no significant
association between any measures of malunion and the WOMAC scores, or the presence
of either clinical or radiological osteoarthritis.
It is concluded that femoral shaft malunion and malalignment does not cause an excess
of knee arthritis at 22-year follow-up. However, a significant number of this cohort
has developed mild symptoms of ipsilateral knee pain or stiffness at a median age
of 42 years; the long-term significance of this is not known.
Keywords
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Article info
Publication history
Accepted:
June 22,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
