Abstract
BACKGROUND: Participation in American-style football (ASF) results in trauma-related concerns including joint injuries. Limited work has described arthritis and knee and hip total joint arthroplasty (TJA) in this population. The association of these conditions to pain interference and physical and mental function has not been well described.
OBJECTIVES: 1. To characterize demographic, football, and health-related factors in former ASF players associated with arthritis and knee or hip TJA. 2. To investigate the association of arthritis and knee or hip TJA with pain interference and physical and mental function.
STUDY DESIGN: Cross-sectional cohort study.
SETTING: Academic medical multisite hospital system.
PARTICIPANTS: Former ASF players who played professionally from 1960 to 2019.
ASSESSMENT OF RISK FACTORS: Self-completed standardized questionnaires.
MAIN OUTCOME MEASURES: Surveys included self-reported arthritis and knee and hip TJA, Patient-Reported Outcome Measure Instrument Scale (PROMIS), physical function and mental function, and pain interference scales. Multivariable logistic regression models assessed the association between demographic, football-related, and health characteristics with arthritis and knee and hip TJA. Multivariable linear regression models evaluated the association between arthritis and knee and hip TJA with pain interference and physical and mental function.
RESULTS: In 4189 former ASF players (average and SD: 51.8 ± 14.4 years old) over half (n = 2237, 53.4%) had arthritis (n = 1547) or knee or hip TJA (n = 690). Both arthritis and knee and hip TJA were more common in those who were older, with higher body mass index, and prior surgery during playing years and were linemen (p < .05). Additionally, arthritis was more common in players who were never married (p = .01) and with higher concussion symptoms score (p < .001). Knee and hip TJA were more common in players who self-identified as White (p < .001). Both arthritis and knee and hip TJA were associated with greater pain interference and reduced physical function (all p < .001) but not with mental function.
CONCLUSION: More than half of former ASF players reported arthritis or knee or hip TJA. Higher pain interference and reduced physical function in former ASF players with arthritis and knee or hip TJA highlight the importance of advancing strategies to prevent and treat joint conditions.