A Five-Year Longitudinal Assessment of Quality of Life and Employment Status in Patients Who Have Osteonecrosis of the Femoral Head Undergoing Femoral Osteotomy: A Multicenter Study

Background: The impact of femoral osteotomy on the quality of life (QOL) and employment status in patients who have osteonecrosis of the femoral head (ONFH) remains inadequately characterized. This multicenter study aimed to evaluate the longitudinal changes in QOL and employment status among patients who have ONFH undergoing femoral osteotomy. Methods: There were 35 patients (18 men, 17 women; mean age 32 years) who underwent femoral osteotomy for ONFH included. Self-reported QOL assessments were conducted using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, Oxford Hip Score, and the 12-Item Short-Form Health Survey Version 2 at six months, one year, two years, and five years postoperatively. Employment status was evaluated via questionnaires administered. Results: Significant improvements were observed in all domains of the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, Oxford Hip Score, and the physical component summary score of 12-Item Short-Form Health Survey version 2 over the 5-year postoperative period. Pain-related items and basic movement functions showed marked improvement by one year postoperatively, while “limping while walking” improved significantly by two years. Activities such as “squatting” and “using a Japanese-style toilet” demonstrated substantial improvements only by the 5-year follow-up. Preoperatively, 26 out of 35 patients (74.3%) were employed, while 24 out of 35 patients (68.6%) were employed at five years postoperatively. The proportion of patients reporting significant work-related impairment decreased from 80.7% preoperatively to 7.7% at five years. Similarly, “anxiety about job continuation” was reduced from 73.1% preoperatively to 34.6% at five years. Conclusions: The findings indicate that while recovery of physical function following femoral osteotomy requires an extended duration, significant improvements in QOL and functional capabilities can be achieved. Furthermore, work-related impairments and associated anxiety diminished substantially within five years postoperatively, suggesting that middle-aged patients undergoing femoral osteotomy are often able to resume and sustain employment in the long term.