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Deleu PA, Piron M, Leemrijse G, Besse JL, Chèze L, Devos Bevernage B, Lalevée M, Leemrijse T. Patients' point of view on the long-term results of total ankle arthroplasty, tibiotalar and tibiotalocalcaneal arthrodeses. Orthop Traumatol Surg Res 2022; 108:103369. [PMID: 35850423 DOI: 10.1016/j.otsr.2022.103369] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/16/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total ankle arthroplasty (TAA), tibiotalar (TT) arthrodesis and tibiotalocalcaneal (TTC) arthrodesis are common surgical procedures that are sometimes concurrent. The functional results of TTC are deemed to be inferior because of the double joint sacrifice. Patient-Reported Outcome Measures (PROMs), as well as satisfaction scores, are commonly used to assess the outcome of these surgeries, but lack at capturing patients' ability to cope with potential functional limitations. The objective of our study was to compare the results of TAA, TT and TTC arthrodeses according to patients' point of view. We proposed two hypotheses: 1) TAA confer better results than TT arthrodeses, 2) and TT arthrodeses confer better results than TTC arthrodeses, on this specific criterion. MATERIAL AND METHODS We carried out a retrospective study integrating all TAA, TT and TTC arthrodeses performed in our center from 2010 to 2017. These surgeries were compared using PROMs (Foot Function Index (FFI), Foot and Ankle Outcome Scale (FAOS) and 12-Item Short Form Survey (SF-12)), a satisfaction rating and self-reported perceived recovery state. RESULTS Fifty-one patients were included in the TAA group, 50 in the TT group and 51 in the TTC group. The mean duration of follow-up was 46±20.8 months. The TAA group had better results than the TT group regarding the FFI score and satisfaction, thus confirming our primary hypothesis. On the other hand, no significant difference was found between the TT group and the TTC group, which invalidated our secondary hypothesis. No significant difference between the groups was found regarding the distribution of patients' perceived recovery state. CONCLUSION Our hypothesis was not confirmed. In fact, TAAs, TT and TTC arthrodeses presented substantially similar results. Although it is difficult to compare surgeries with different indications, it is surprising to find that the patients' perceived recovery state, deviating from the usual clinical and radiological results, are relatively similar. LEVEL OF EVIDENCE IV; Retrospective study.
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Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France; Foot & Ankle Institute, Bruxelles, Belgium.
| | - Maud Piron
- Centre Hospitalier Régional La Citadelle, Liège, Belgium
| | | | - Jean-Luc Besse
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, 69495 Pierre-Bénite, France
| | - Laurence Chèze
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France
| | | | - Matthieu Lalevée
- Centre Hospitalo-Universitaire de Rouen, Service de chirurgie Orthopédique et Traumatologique, 76000 Rouen, France
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Lachman JR, Green CL, Adams SB, Nunley JA, DeOrio JK, Easley ME. Improvement in Health-Related Quality of Life After Total Ankle Arthroplasty Compares Well With Other Successful Orthopaedic and Nonorthopaedic Procedures. Foot Ankle Spec 2021; 14:427-437. [PMID: 32396466 DOI: 10.1177/1938640020917782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Ankle arthritis is a major cause of disability. Orthopaedic literature suggests improvement in health-related quality of life (HRQOL) after total ankle arthroplasty (TAA). This has not been compared with improvements observed in successful orthopaedic and nonorthopaedic procedures, including anterior cervical discectomy/fusion (ACDF), total knee arthroplasty (TKA), coronary artery bypass grafting (CABG), and orthotopic liver transplant (OLT). We hypothesize that the effects after TAA are comparable to several successful surgical procedures. Methods. 500 consecutive TAA patients were included and grouped with 2 other large series. Short Form-36 (SF36) were collected at standardized intervals. A systematic literature review identified studies comparing preoperative and postoperative SF36 physical (PCS) and mental component summary (MCS) scores. Using meta-analyses, we pooled the data for each procedure to compare with the TAA group. Results. Patients in all cohorts had preoperative SF36 MCS and PCS scores that were significantly lower than that in the general population. Improvements in HRQOL after TAA were not statistically different from improvements reported in PCS and MCS after ACDF, TKA, and OLT. However, improvement in PCS after TAA was better than that observed after CABG. Conclusions. Disability with ankle arthritis is severe. Disability associated with cervical disc disease, knee arthrosis, coronary artery disease, and liver failure is also severe, with surgical intervention providing major improvements in HRQOL postoperatively. The improvement in HRQOL after TAA did not differ statistically from ACDF, TKA, CABG, and OLT. Our investigation suggests that the HRQOL benefits of TAA meet benchmarks set by some of modern medicine's best.Levels of Evidence: Level III: Systematic review.
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Affiliation(s)
- James R Lachman
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - Cynthia L Green
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - Samuel B Adams
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - James A Nunley
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - James K DeOrio
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
| | - Mark E Easley
- St Luke's University Health Network, Quakertown, Pennsylvania (JRL).,Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina (CLG).,Duke University School of Medicine, Durham, North Carolina (SBA, JAN, JKD, MEE)
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Mehta MP, Mehta MP, Sherman AE, Mutawakkil MY, Bell R, Patel MS, Kadakia AR. Evaluating Prospective Patient-Reported Pain and Function Outcomes After Ankle and Hindfoot Arthrodesis. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211040740. [PMID: 35097472 PMCID: PMC8559232 DOI: 10.1177/24730114211040740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hindfoot and ankle fusions are mechanically limiting procedures for patients. However, patient-reported outcomes of these procedures have not been well studied. This study assessed outcomes of hindfoot and ankle fusions by using Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs). Methods: Between 2014 and 2018, 102 patients were prospectively enrolled after presenting to a tertiary care facility for ankle and hindfoot fusions, including tibiotalar, tibiotalocalcaneal, subtalar, and triple arthrodeses. Study participants completed preoperative and 12-month postoperative PF and PI CATs. The differences between mean 12-month postoperative and preoperative PROMIS PF and PI T scores were analyzed with paired t tests. The relationship between the 12-month PF and PI differences for the overall sample and patient factors was examined using multiple regression modeling. Results: The sample had mean age of 57.69 years; 48% were male, and 55% were obese. Patients who underwent ankle and hindfoot arthrodesis had statistically significant improvements from preoperative to 12 months postoperative in mean PF (36.26±7.85 vs 39.38±6.46, P = .03) and PI (61.07±7.75 vs 56.62±9.81, P = .02). Triple arthrodesis saw the greatest increases in physical function (▵PF = 7.22±7.31, P = .01) and reductions in pain (▵PI = –9.17±8.31, P = .01), achieving minimal clinically important difference (MCID). Patients who underwent tibiotalar fusion had significant improvement in physical function (▵PF = 4.18±5.68, P = .04) and pain reduction that approached statistical significance (▵PI = –6.24±8.50, P = .09), achieving MCID. Older age (≥60 years ) was associated with greater improvements in PF (β = 0.20, P = .07) and PI (β = –0.29, P = .04). Preoperative PF and PI T scores were significantly associated with the 12-month change in PF and PI T scores, respectively (β = –0.74, P < .01; β = –0.61, P < .01). Conclusion: Hindfoot and ankle fusions are procedures with favorable patient outcomes leading to increased physical function and decreased pain at 12 months postoperation relative to preoperation. Level of Evidence: Level II, prospective comparative study.
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Affiliation(s)
- Manish P. Mehta
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mitesh P. Mehta
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alain E. Sherman
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Muhammad Y. Mutawakkil
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Raheem Bell
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Milap S. Patel
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anish R. Kadakia
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Shah NS, Umeda Y, Suriel Peguero E, Erwin JT, Laughlin R. Outcome Reporting in Total Ankle Arthroplasty: A Systematic Review. J Foot Ankle Surg 2021; 60:770-776. [PMID: 33766479 DOI: 10.1053/j.jfas.2021.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 02/03/2023]
Abstract
Total ankle arthroplasty is an increasingly utilized treatment for ankle arthritis due to decreasing failure rates and improved outcomes. However, the literature on this procedure remains heterogeneous with large variability in outcome reporting methods. PRISMA guidelines were used to systematically review outcome reporting measures used in prospective studies and randomized control trials on total ankle arthroplasty published in 15 high-impact journals between Jan 1, 2009-May 1, 2020. A total of 43 studies were included and outcome measures were grouped into seven categories: pain, subjective function, patient satisfaction, complications, objective function, implant survivorship, and imaging. The most common topic of study was implant design followed by differences in outcomes when comparing total ankle arthroplasty and arthrodesis. The most commonly reported outcome measure was post-surgical complications. No study reported on all seven categories, while 22 (51.2%) studies reported on four or more. Subjective measures had significant variability with fifteen different Patient Reported Outcome Measures used across the studies. While the included studies were quite comprehensive, there was little consistency in reporting outcomes after total ankle arthroplasty. With improving outcomes and techniques in total ankle arthroplasty, and thus an expected increase in utilization and number of published studies, efforts should be made to use commonly employed outcome reporting methods to facilitate comparison of results across studies.
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Affiliation(s)
- Nihar S Shah
- Research Fellow, Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Yuta Umeda
- Medical Student, Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Emil Suriel Peguero
- Medical Student, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Jace T Erwin
- Resident, Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Richard Laughlin
- Professor, Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
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Rushing CJ, Rathnayake VR, Oxios AJ, Spinner SM, Hardigan P. Patient-Perceived Recovery and Outcomes after Bipolar Radiofrequency Controlled Ablation with Platelet-Rich Plasma Injection for Refractory Plantar Fasciosis. J Foot Ankle Surg 2021; 59:673-678. [PMID: 32600560 DOI: 10.1053/j.jfas.2019.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 02/03/2023]
Abstract
Previous studies have documented persistent postoperative symptoms and limitations following plantar fasciotomy using patient-reported outcome measures (PROMs). The incomplete recovery (resolution) has been theorized to occur from altered foot biomechanics, and alternative treatment methods have continued to gained popularity for addressing refractory plantar fasciosis (RPF). The purpose of the present study was to assess patient-perceived recovery (PPR) and outcomes after bipolar radiofrequency controlled ablation (BRC) with platelet-rich plasma (PRP) injection for RPF. From July 2006 to July 2016, 43 patients (52 procedures) were enrolled. PROMS were prospectively obtained and compared between patients who perceived themselves as recovered without/residual deficits (recovered-resolved, recovered-not resolved) and those not recovered. Holistic satisfaction, procedure-specific satisfaction, complications, reoperations, and failure were recorded. Overall, 67.4% perceived themselves as recovered-resolved, 23.3% as recovered-not resolved, and 9.3% as not recovered. Holistic and procedure specific satisfaction were high (90.7% and 88.4%), with a mean modified Foot Function Index of 11.65, visual analog scale for pain 1.5, and failure rate of 9.3% at a median of 53 months (interquartile range 33 to 83). In the present study, outcomes with BRC with PRP injection compared favorably to the long-term outcomes reported for partial and complete plantar fasciotomy. Although 14 patients (32.6%) continued to have some postoperative symptoms, 71% indicated that they were satisfied with their symptoms, and 64% would undergo a similar procedure again. Therefore, despite the study's shortcomings, a patient's ability to cope appears to have a role in recovery from RPF.
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Affiliation(s)
- Calvin J Rushing
- Resident, Westside Regional Medical Center, Plantation, FL; Board Member, Foot and Ankle Research Foundation of South Florida Inc., Plantation, FL.
| | | | - Adam J Oxios
- Resident, Westside Regional Medical Center, Plantation, FL
| | - Steven M Spinner
- Board Member, Foot and Ankle Research Foundation of South Florida Inc., Plantation, FL; Residency Director, Westside Regional Medical Center, Plantation, FL
| | - Patrick Hardigan
- Director, Statistical Consulting Center, Nova Southeastern University, Ft. Lauderdale, FL
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Deleu PA, Naaim A, Leemrijse T, Dumas R, Devos Bevernage B, Besse JL, Crevoisier X, Chèze L. Impact of foot modeling on the quantification of the effect of total ankle replacement: A pilot study. Gait Posture 2021; 84:308-314. [PMID: 33429193 DOI: 10.1016/j.gaitpost.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/17/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kinematic and kinetic foot models showed that computing ankle joint angles, moments and power with a one-segment foot modeling approach alters kinematics and tends to overestimate ankle joint power. Nevertheless, gait studies continue to implement one-segment foot models to assess the effect of total ankle replacement. RESEARCH QUESTION The objective of this pilot study was to investigate the effect of the foot modeling approach (one-segment versus multi-segment) on how total ankle replacement is estimated to benefit or degrade the patient's biomechanical performance. METHODS Ten subjects with post-traumatic ankle osteoarthritis scheduled for total ankle replacement and 10 asymptomatic subjects were recruited. A one-segment and a multi-segment foot model were used to calculate intrinsic foot joints kinematics and kinetics during gait. A linear mixed model was used to investigate the effect of the foot model on ankle joint kinematic and kinetic analysis and the effect of total ankle replacement. RESULTS Differences in range of motion due to the foot model effect were significant for all the gait subphases of interest except for midstance. Peak power generation was significantly overestimated when computed with the one-segment foot model. Ankle and shank-calcaneus joint dorsi-/plantarflexion range of motion did not increase post-operatively except during the loading response phase. A significant 'group' effect was found for stance and pre-swing phase range of motion, with total ankle replacement patients showing lower range of motion values than controls for dorsi/plantarflexion. SIGNIFICANCE The outcome of this study showed that the 'foot model' had a significant effect on estimates of range of motion and power generation. The findings in our study therefore emphasize the clinical interest of multi-segment foot modeling when assessing the outcome of a therapeutic intervention.
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Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France; Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium.
| | - Alexandre Naaim
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
| | - Thibaut Leemrijse
- Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium; CHIREC Delta Hospital, 201 Boulevard Du Triomphe, 1160, Brussels, Belgium.
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
| | - Bernhard Devos Bevernage
- Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium; CHIREC Delta Hospital, 201 Boulevard Du Triomphe, 1160, Brussels, Belgium.
| | - Jean-Luc Besse
- Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud, Service De Chirurgie Orthopédique Et Traumatologique, 69495 Pierre-Bénite Cédex, France.
| | - Xavier Crevoisier
- Department of Orthopedics and Traumatology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Laurence Chèze
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
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Pinsker EB, Sale JEM, Gignac MAM, Daniels TR, Beaton DE. “I Don’t Have to Think About Watching the Ground”: A Qualitative Study Exploring the Concept of Vigilance as an Important Outcome for Ankle Reconstruction. Arthritis Care Res (Hoboken) 2020; 72:1367-1373. [DOI: 10.1002/acr.24039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Ellie B. Pinsker
- St. Michael’s Hospital and University of Toronto Toronto Ontario Canada
| | - Joanna E. M. Sale
- St. Michael’s Hospital and University of Toronto Toronto Ontario Canada
| | | | | | - Dorcas E. Beaton
- Institute of Work & Health and University of Toronto Toronto Ontario Canada
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Eerdekens M, Deschamps K, Wuite S, Matricali G. The Biomechanical Behavior of Distal Foot Joints in Patients with Isolated, End-Stage Tibiotalar Osteoarthritis Is Not Altered Following Tibiotalar Fusion. J Clin Med 2020; 9:jcm9082594. [PMID: 32796511 PMCID: PMC7465493 DOI: 10.3390/jcm9082594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 12/16/2022] Open
Abstract
Ankle arthrodesis is considered to be an optimal treatment strategy to relieve pain during walking in patients with isolated, end-stage tibiotalar osteoarthritis. The aim of this study was to investigate the post-operative effect of an arthrodesis on the ankle and foot joint biomechanics. We included both patients (n = 10) and healthy reference data (n = 17). A multi-segment foot model was used to measure the kinematics and kinetics of the ankle, Chopart, Lisfranc, and first metatarsophalangeal joints during a three-dimensional (3D) gait analysis. These data, together with patient reported outcome measures, were collected at baseline (pre-operative) and one year post-operatively. Patients experienced a decrease in pain and an increase in general well-being after surgery. Compared to the baseline measurements, patients only demonstrated a significant average post-operative increase of 0.22 W/kg of power absorption in the ankle joint. No other significant differences were observed between baseline and post-operative measurements. Current findings suggest that the biomechanical behavior of distal foot joints is not altered one year after fusion. The pain relief achieved by the arthrodesis improved the loading patterns during walking. Clinical significance of this study dictates that patients do not have to fear a loss in biomechanical functionality after an ankle arthrodesis.
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Affiliation(s)
- Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, 3001 Heverlee, Belgium
- Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, 3210 Pellenberg, Belgium;
- Correspondence:
| | - Kevin Deschamps
- Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, 3210 Pellenberg, Belgium;
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, 8000 Campus Brugge, Belgium
| | - Sander Wuite
- Department of Orthopedics, UZ Leuven, 3000 Leuven, Belgium; (S.W.); (G.M.)
- Institute for Orthopaedic Research & Training, KU Leuven, 3000 Leuven, Belgium
- Department of development and regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Giovanni Matricali
- Department of Orthopedics, UZ Leuven, 3000 Leuven, Belgium; (S.W.); (G.M.)
- Institute for Orthopaedic Research & Training, KU Leuven, 3000 Leuven, Belgium
- Department of development and regeneration, KU Leuven, 3000 Leuven, Belgium
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Kohring JM, Houck JR, Oh I, Flemister AS, Ketz JP, Baumhauer JF. Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study. J Patient Rep Outcomes 2020; 4:40. [PMID: 32462241 PMCID: PMC7253567 DOI: 10.1186/s41687-020-00203-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication. Methods This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected as routine care. Linear mixed models were used to assess differences at each follow-up point for PF and PI. Preoperative to last follow-up in the 120–365 day interval was assessed using analysis of variance. Outcomes included T-scores, z-scores, and PROMIS-Preference (PROPr) utility scores for PF and PI and the percentage of patients improving by at least 4 T-score points. Results The linear mixed model analysis for PF after the 120–149 days, and for PI, after 90–119 days, indicated recovery plateaued at 39–40 for PF and 57–59 for PI T-scores. The change in the PI T-score was the greatest with a mean T-score improvement of − 5.4 (95% CI − 7.7 to − 3.1). The proportion of patients improving more than 4 points was 66.2% for either PF or PI or both. The change in utility T-scores for both PF (0.06, 95% CI 0.02 to 0.11) and PI (0.15, 95% CI 0.09 to 0.20) was significantly improved, however, only PI approached clinical significance. Conclusion Average patients undergoing ankle fusion experience clinically meaningful improvement in pain more so than physical function. Average patient recovery showed progressive improvement in pain and function until the four-month postoperative time point. Traditional dogma states that recovery after an ankle fusion maximizes at a year, however based on the findings in this study, 4 months is a more accurate marker of recovery. A decline in function or an increase in pain after 4 months from surgery may help to predict nonunion and other complications after ankle arthrodesis. Level of evidence Level II, prospective single cohort study.
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Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Jeffrey R Houck
- Department of Physical Therapy, George Fox University, Newberg, OR, USA
| | - Irvin Oh
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Adolf S Flemister
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - John P Ketz
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Judith F Baumhauer
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.
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Change in gait biomechanics after total ankle replacement and ankle arthrodesis: a systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2020; 73:213-225. [PMID: 32044672 DOI: 10.1016/j.clinbiomech.2020.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/21/2019] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this systematic review with meta-analysis was to determine the change in gait biomechanics after total ankle replacement and ankle arthrodesis for end-stage osteoarthritis. METHODS Electronic databases were searched up until May 2019. Peer-reviewed journal studies including adult participants suffering from end-stage ankle osteoarthritis and reporting pre- and post-operative kinematics, kinetics and spatio-temporal effects of total ankle replacement and ankle arthrodesis during walking were included with a minimum of 12 months follow-up. Seventeen suitable studies were identified and assessed according to methodological and biomechanical qualities. Meta-analysis was performed by calculating the effect size using standard mean differences between pre- and post-operative gait status. FINDINGS Seventeen studies with a total of 883 patients were included. Meta-analysis revealed moderate evidence of an improvement in lower limb kinematics, kinetics and spatio-temporal parameters after total ankle replacement. Moderate evidence indicated an increase in ankle moment, hip range of motion and walking speed after ankle arthrodesis. INTERPRETATION The currently available evidence base of research papers evaluating changes in gait biomechanics after total ankle replacement and ankle arthrodesis is limited by a lack of prospective research, low sample sizes and heterogeneity in the patho-etiology of ankle osteoarthritis. Following total ankle replacement, improvements were demonstrated for spatio-temporal, kinematic and kinetic gait patterns compared to the pre-operative measures. Improvements in gait mechanics after ankle arthrodesis were limited to walking speed and ankle moment. Increased hip range of motion after ankle arthrodesis could represent a sign of compensation for the lack of ankle motion.
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Rushing CJ, Rathnayake VR, Oxios AJ, Galan GP, Ramil M, Spinner SM, Hardigan P. Patient-Perceived Recovery and Outcomes After Silastic Implant Arthroplasty. J Foot Ankle Surg 2019; 57:1080-1086. [PMID: 30172719 DOI: 10.1053/j.jfas.2018.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Indexed: 02/03/2023]
Abstract
In some chronic musculoskeletal conditions, patients with persistent pain and disability have still achieved recovery through behavioral adaptations (readjustment) or cognitive coping (redefinition). Although the pendulum shift from physician-reported clinical indicators to patient-reported outcomes measures (PROMs) has recently focused on quantifying residual pain and disability to determine recovery (resolution), whether patients are capable of coping with any ongoing deficits and achieving other forms of recovery has not been considered. We performed a retrospective case series to assess patient-perceived recovery and outcomes after silastic implant arthroplasty for hallux rigidus. From July 2006 to July 2016, 28 patients at a single institution were enrolled. PROMs were prospectively obtained and compared between patients considering themselves recovered without or with residual deficits (recovered-resolved, recovered-not resolved) and those not recovered. Holistic satisfaction, procedure-specific satisfaction, complications, reoperations, and failure rates were recorded. Overall, 50.0% perceived themselves as recovered-resolved, 43% as recovered-not resolved, and 7% as not recovered. The mean modified Foot Function Index was 17.26, the verbal analog scale for pain score was 2.03, and implant survivorship 100% at a median of 67 (interquartile range 28.4 to 103.5) months. Although only 50% of patients reported complete symptom resolution, satisfaction was high, and most perceived themselves as recovered, suggesting recovery in hallux rigidus might not always be predicated by the complete resolution of all symptomatology. Although PROMs relying on pain inference and functional disability will continue to be utilized with increasing frequency, foot and ankle surgeons should be cognizant of their inherent limitations in assessing other forms of recovery.
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Affiliation(s)
| | | | - Adam J Oxios
- Resident, Westside Regional Medical Center, Plantation, FL
| | | | - Madelin Ramil
- Research Director, Westside Regional Medical Center, Plantation, FL
| | - Steven M Spinner
- Residency Director, Westside Regional Medical Center, Plantation, FL
| | - Patrick Hardigan
- Director, Statistical Consulting Center, Nova Southeastern University, Fort Lauderdale, FL
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Outcome after 52 Salto Ankle Prostheses Implanted by a Single Surgeon. Adv Orthop 2018; 2018:2735634. [PMID: 30155313 PMCID: PMC6092980 DOI: 10.1155/2018/2735634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 12/26/2022] Open
Abstract
While ankle arthrodesis was traditionally the gold standard method of treatment for disabling end-stage ankle arthritis, total ankle replacement (TAR) has been an acceptable alternative. The satisfaction rate of patients with TAR however differs. The purpose of our study is to investigate whether implant survival and results with special emphasis on the satisfaction rate of patients treated with a TAR implanted by a single surgeon were comparable to the literature. This was a retrospective cohort study in a teaching hospital. Data was collected from 52 patients who received a total ankle replacement (TAR) between 05/2002 and 06/2014. The mean follow-up time was 4.2 years (95% CI 3.3 - 5.0). Results showed a high satisfaction rate of 94% and 94% survival of the TAR after 5 years. We conclude that TAR with the Salto prosthesis is, in our hands, a reliable solution for end-stage ankle arthritis, with results comparable to the literature.
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