The effects of acetabular fractures on functional status and predictors of no full recovery : results of a five-year prospective cohort study.

Aims: Acetabular fractures have major personal and societal impact. However, prospective longitudinal data about the patient's recovery trajectory is scarce. Therefore, we aimed to assess the course of the patient's functional recovery, up till five years post-injury. Additionally, predictors of no full recovery and patient's perception of most experienced difficulties were assessed. Methods: A prospective longitudinal cohort study was performed, including adult patients treated for an acetabular fracture at a level 1 trauma centre between January 2017 and August 2023. Patient-reported outcome measures (PROMs) were used to assess functional status with the Short Musculoskeletal Function Assessment (SMFA) at baseline (recalled pre-injury), six weeks, three and six months, and one, two, and five years post-injury. We assessed whether patients had returned to their baseline level health status. Predictors for incomplete recovery were identified using logistic regression analysis. The most frequently experienced difficulties were presented by analyzing the highest reported scores on individual items of the SMFA. Results: A total of 202 patients with an acetabular fracture filled out the PROMs. After two and five years of follow-up,109 out of 148 (74%) and 65 out of 83 (78%) of the patients fully recovered in terms of physical functioning, respectively. Patients with a posterior wall fracture had worse outcome compared to other Letournel fracture types. Enduring high-energy trauma and not being fully recovered on the SMFA emotion subscale at three months were independent predictors for incomplete recovery after two years on the SMFA function index. At two years, the most frequently reported severe difficulties were walking with a limp and feeling disabled. Conclusion: Acetabular fractures significantly affect patient-reported functional status, with an initial decline until three months, followed by rapid improvement between three to six months, and gradual recovery up until five years following the injury. Patients with posterior wall fractures showed worse outcomes. High-energy trauma was the strongest predictor for incomplete recovery. The most frequently reported difficulties were walking with a limp and feeling disabled.