Debilitating Effects of Femoral Nonunion on Health-Related Quality of Life

OBJECTIVE: The purpose of this study was to report the extent of the effects of femoral nonunion on health-related quality of life. DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS/PARTICIPANTS: One hundred eighty-seven consecutive patients (85 women, age 55.9 ± 16.9 years; 102 men, age 42.8 ± 16.1 years) with 188 nonunions of the femur, excluding those involving the hip or knee articular surfaces. INTERVENTION: Average nonunion duration was 28.5 months. 5.7% of the nonunions were infected, and the distal third was the most frequently involved segment. MAIN OUTCOME MEASUREMENTS: SF-12 Mental Component Summary (MCS) and Physical Component Summary (PCS) scores, Brief Pain Inventory (BPI), American Academy of Orthopaedic Surgeons Lower Limb Core Scale (LLCS), and Time Trade-Off (TTO) reported at the time of initial clinical evaluation at our center. RESULTS: The MCS scores averaged 43 ± 6.5, and the PCS scores averaged 26.3 ± 6.5, indicating the large adverse impact of femoral nonunion on mental and physical health, respectively. The BPI average intensity score averaged 5.1 ± 2.5, indicating moderate to severe pain. The LLCS averaged 53.9 ± 20.0, indicating substantial lower extremity-specific disability. The TTO questionnaire responses indicated that these patients were willing to trade an average of 38.3% of their remaining years of life to regain health. CONCLUSIONS: The impact of femoral shaft nonunion on physical health was comparable to end-stage hip arthrosis and tibial nonunion and worse than many other medical conditions. Femoral shaft nonunion is a debilitating chronic medical condition with substantial negative effects on health. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.