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Mai C, Mai P, Hinz M, Saenger R, Seil R, Tischer T, Roessler PP. Females show worse functional outcome and quality of life compared to males 2 years after meniscus surgery: Data analysis from the German Arthroscopy Registry. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38454792 DOI: 10.1002/ksa.12131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE The purpose of this study was to investigate the impact of sex on knee function, activity and quality of life following meniscus surgery using data from the German Arthroscopy Registry. METHODS This is a retrospective cohort study with data collected between 2017 and 2022. Patient-reported outcome measures (PROMs), namely Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQol Visual Analogue Scale (EQ Scale), and Marx Activity Rating Scale (MARS), were collected preoperatively and at 6, 12 and 24 months postoperatively. Data were analysed to examine differences between male and female patients regarding PROMs, pre-existing conditions, meniscus lesion types and surgical treatments. RESULTS A total of 1106 female (36.6%) and 1945 male patients (63.7%) were included. Males were significantly younger than females and had a higher body mass index. Overall, there were four times more medial meniscus lesions (MMLs) (77.5%) than lateral meniscus lesions (LMLs) (27.9%). Degenerative LMLs were more frequent in females, while traumatic LMLs were more common in males. Frequencies of traumatic and degenerative MMLs were similar among males and females. Males had higher absolute KOOS irrespective of treatment or meniscus lesion type. Meniscus repair resulted in similar improvements in ΔKOOS for both sexes, while meniscus resection exhibited higher absolute KOOS for males at each time point. Males generally had higher EQ Scale and MARS than females. CONCLUSION Greater improvements in knee function, activity and quality of life were observed in males. While MMLs appear to be comparable among sexes, the nature of LML differed significantly. These results may help surgeons to refine patient selection for specific treatments to improve overall clinical outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Celine Mai
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Patrick Mai
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
- Institute of Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Rebecca Saenger
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg City, Luxembourg
| | - Thomas Tischer
- Department of Orthopaedic and Trauma Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | - Philip P Roessler
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
- Gelenkzentrum Mittelrhein, Koblenz, Germany
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Söderpalm AC, Montgomery F, Helander KN, Cöster MC. Hallux valgus; An observational study on patient characteristics, surgical treatment and pre-operative HRQoL from the Swedish foot and ankle register (Swefoot). Foot (Edinb) 2023; 57:102060. [PMID: 37922633 DOI: 10.1016/j.foot.2023.102060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Hallux valgus (HV) is a common condition with impact on pain, function and HrQoL. International consensus does not exist on operative treatment of HV and population-level data regarding surgical treatment of HV is lacking. In this study we aimed to present base-line data from surgically treated HV patients reported to the Swedish register for foot and ankle surgery (Swefoot) during the period 2014-2021. MATERIAL AND METHODS In total, 7543 feet in 6770 patients were analyzed regarding patient characteristics, grading of HV, surgical procedures and pre-operative PROMs Euroqol-5 Dimension-3 L (EQ-5D-3 L) and Self-reported Foot and Ankle Score (SEFAS). RESULTS Median age was 55 years (range 15-91) and 87% were women. The surgeon classified 63% of the cases as moderate HV, 15% as mild and 22% as severe. The Chevron osteotomy was the preferred surgical method and was used in 74% of all cases. Out of these, 58% were fixated with a screw. The Offset-V osteotomy was the most performed shaft osteotomy. Proximal osteotomies and lateral releases were less common. The pre-operative mean EQ-5D-3 L index and SEFAS summary score were low and HV patients with overweight and rheumatoid arthritis had significantly lower scores. CONCLUSION This is the first report from Swefoot describing surgeon- and patient reported pre-operative data in patients with surgical treated HV.
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Affiliation(s)
- Ann-Charlott Söderpalm
- Capio Orthocenter, Gothenburg, Sweden; Department of Orthopedics and Clinical Sciences in Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Fredrik Montgomery
- Department of Orthopedics and Clinical Sciences in Malmö, Lund University, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopedics and Clinical Sciences in Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Maria C Cöster
- Department of Orthopedics and Clinical Sciences in Malmö, Lund University, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Capio Movement, Halmstad, Sweden
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Larsen P, Rathleff MS, Roos EM, Elsoe R. Foot and Ankle Outcome Score (FAOS): Reference Values From a National Representative Sample. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231213369. [PMID: 38058979 PMCID: PMC10697047 DOI: 10.1177/24730114231213369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Background The Foot and Ankle Outcome Score (FAOS) is widely used in clinical practice and research. However, FAOS reference values are missing to aid interpretation. This study aimed to establish national record-based reference values for the FAOS. Methods A national representative sample of 9996 adult Danish citizens was derived from the Danish Civil Registration System. The FAOS questionnaire was sent to all participants, including 2 supplemental questions regarding previous foot and ankle problems and body mass index (BMI). A threshold of 10 FAOS points was predefined as a clinically relevant difference across all 5 subscales. Results A total of 2759 participants completed the FAOS. Mean age of participants was 60.5 years, and 51% were women. The mean FAOS subscale scores were as follows: pain, 87.1 (95% CI 86.4-87.8); symptoms, 85.1 (95% CI 84.5-85.8); activity of daily living (ADL), 88.9 (95% CI 88.2-89.6); sport and recreation function 78.5 (95% CI 77.4-79.6); and quality of life (QOL), 79.9 (95% CI 79.0-80.9). The mean difference between men and women was small and not clinically relevant (ranged from 0.9 in ADL to 3.4 in QOL). The largest differences in mean scores between age groups ranged from 4.3 in symptoms to 16.4 in sport/rec. Except for the subscale sport/rec, all age-related differences were below the predefined threshold of 10 for clinical relevance. The difference in mean subscale scores between the lowest BMI group (<24.7) and the obese group (>30) ranged from 19.6 in ADL to 39.1 in sport/rec. Conclusion We found in our population that BMI severely impacted FAOS scores. We recommend using BMI-specific reference FAOS values. Separate FAOS reference values for men and women appear not needed. Stratifying reference values for age is likely not needed except for the subscale sport and recreation function. Level of evidence Level III, cohort study.
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Affiliation(s)
- Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Michael S. Rathleff
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Ewa M. Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Rasmus Elsoe
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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Zhang Y, Ren J, Zang Y, Guo W, Disantis A, Martin RL. Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity. Int J Sports Phys Ther 2023; V18:653-686. [PMID: 37425110 PMCID: PMC10324371 DOI: 10.26603/001c.74528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown. Purpose The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization. Study design Literature Review. Methods PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data. Results Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use. Conclusion Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use. Level of evidence 3a.
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Affiliation(s)
- Yongni Zhang
- Rangos School of Health Sciences Duquesne- China Health Institute
| | - Jiayi Ren
- Shuguang Hospital of Shanghai University of Traditional Chinese Medicine
| | - Yaning Zang
- Department of Kinesiology Shanghai University of Sport
| | - Wenhao Guo
- Rangos School of Health Sciences Duquesne- China Health Institute
| | - Ashley Disantis
- Department of Physical Therapy Duquesne University
- UPMC Children's Hospital of Pittsburgh
| | - Robroy L Martin
- Department of Physical Therapy Duquesne University
- UPMC Center for Sports Medicine
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Cöster MC, Cöster A, Svensson F, Callréus M, Montgomery F. Swefoot - The Swedish national quality register for foot and ankle surgery. Foot Ankle Surg 2022; 28:1404-1410. [PMID: 35933290 DOI: 10.1016/j.fas.2022.07.010] [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: 12/09/2021] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Population-based register data could be used to improve our knowledge of patients surgically treated for foot and ankle disorders. The quality register Swefoot was recently created to collect surgical and patient-reported data of foot and ankle surgery. This manuscript aims to describe the development and current use of the register. METHODS The development of Swefoot started in 2014 and currently, data on 16 different diagnoses are collected in 49 units performing foot and ankle surgery. Registrations are performed by the surgeon and the patient. RESULTS Between 2014 and 2020 approximately 20,000 surgical procedures have been registered. 75.1% of the registered patients were women, 9.3% were smokers, 9.3% had a concomitant rheumatoid disease, and 18.4% a BMI larger than 30 kg/m2. CONCLUSIONS: The Swefoot is a unique national register for foot and ankle surgery. It is by now possible to present demographic, surgical, and outcome parameters based on Swefoot.
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Affiliation(s)
- Maria C Cöster
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden; Center of Registers Västra Götaland, Sweden; Uppsala University Hospital, Sweden; Skåne University Hospital, Sweden.
| | | | - Fredrik Svensson
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden; Skåne University Hospital, Sweden
| | - Mattias Callréus
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden; Skåne University Hospital, Sweden
| | - Fredrik Montgomery
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden
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Pilskog K, Gote TB, Odland HEJ, Fjeldsgaard KA, Dale H, Inderhaug E, Fevang JM. Association of Delayed Surgery for Ankle Fractures and Patient-Reported Outcomes. Foot Ankle Int 2022; 43:762-771. [PMID: 35184581 PMCID: PMC9168892 DOI: 10.1177/10711007211070540] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several studies probe the association between prolonged time to surgery and postoperative complications in ankle fractures, but little is known about how a longer wait time affects clinical outcomes. The present study aims to assess the association between time from injury to surgery and patient-reported outcomes after operative treatment of severe ankle fractures. METHOD Patients treated operatively for low-energy ankle fractures that also involve the posterior malleolus from 2014 to 2016 were included. Patient charts were reviewed for patient demographics, type of trauma, fracture characteristics, treatment given, and complications. Ankle function was evaluated on a follow-up visit by clinical examination, radiographs, and patient-reported outcome measures (Self-Reported Foot and Ankle Score [SEFAS], RAND-36, visual analog scale [VAS] of Pain, VAS of Satisfaction). We compared patients treated within 1 week to those treated later than a week from injury for analyses. RESULTS Follow-up visits of 130 patients were performed at mean 26 (SD 9) months after surgery. Patient demographics and fracture characteristics were similar between groups. Mean SEFAS was 34 (SD 10) in patients treated later than a week from injury vs 38 (SD 9) in those treated earlier (P = .012). Patients operated on later than 7 days from injury reported more pain (P = .008) and lower satisfaction than those treated earlier (P = .016). CONCLUSION In this retrospective patient series of low-energy ankle fractures with posterior malleolar fragments, we found that waiting >7 days for definitive surgery was associated with poorer clinical outcomes and more pain compared with those who had surgery earlier. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Kristian Pilskog
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen,Kristian Pilskog, MD, Orthopedic Department, Haukeland University Hospital, Pb. 1400, Bergen, 5021, Norway.
| | | | | | | | - Håvard Dale
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
| | - Eivind Inderhaug
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
| | - Jonas Meling Fevang
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
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Hallux rigidus - Osteoarthritis of the first MTP-joint. Surgical and patient-reported results from Swefoot. Foot Ankle Surg 2021; 27:555-558. [PMID: 32859495 DOI: 10.1016/j.fas.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/14/2020] [Accepted: 07/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Swefoot is a Swedish national registry, that covers surgery in the foot and ankle. Surgical treatment of hallux rigidus (HR) vary within and between countries. The aim of this study was to report baseline variables for patients with HR. METHODS We extracted baseline characteristics, surgical procedures and patient-reported data for patients with HR entered in the registry during the period January 2014 to August 2019. RESULTS By August 2019, 1818 patients were reported in the registry. 68.9% of the patients were women, the average age was 58 years, the mean BMI was 26.4kg/m2. 41.9% of the patients underwent a cheilectomy,19.8% a metatarsal osteotomy, 34.3% a fusion, 0.2% an arthroplasty, 0.3% Keller's procedure and 3.5% other methods. The preoperative summary score for SEFAS (Self-reported Foot and Ankle Score) was 26 and for EQ-5D (Euroqol-5 Dimension) 0.60. CONCLUSION This study is the first report from Swefoot regarding HR.
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Erichsen JL, Jensen C, Larsen MS, Damborg F, Viberg B. Danish translation and validation of the Self-reported foot and ankle score (SEFAS) in patients with ankle related fractures. Foot Ankle Surg 2021; 27:521-527. [PMID: 32980265 DOI: 10.1016/j.fas.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Self-reported Foot and Ankle Score (SEFAS) is a patient-reported outcome measure used to evaluate foot and ankle disorders. The purpose of this study was to translate, cross-culturally adapt and validate the Danish language version of the SEFAS in patients with ankle-related fractures. METHODS Forward-backward translation, cross-cultural adaption and validation were performed. In total, 125 patients completed the SEFAS-DK and the Danish version of American Orthopaedic Foot and Ankle Score (AOFAS-DK) at three time points after the date of fracture. The evaluation was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. RESULTS The intra-class correlation coefficient (ICC) level of the SEFAS-DK total score was 0.93 (95% confidence interval [CI]: 0.88-0.96). Cronbach's alpha (CA) for the SEFAS-DK was 0.93, while the floor and ceiling effect at week 6 post-injury was 22.4%. Construct validity was correlated with the AOFAS, and >75% of the pre-defined hypotheses could be confirmed. Responsiveness was analysed using longitudinal data. The minimal clinical important change (MCIC) showed that the SEFAS-DK detects changes in physical function over time. CONCLUSION The Danish version of the SEFAS showed overall good reliability, validity and responsiveness. SEFAS-DK can be used to evaluate physical function in patients with ankle-related fractures. LEVEL OF EVIDENCE level II, prospective cohort study.
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Affiliation(s)
- J L Erichsen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern, Sygehusvej 24, 6000 Kolding Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B Winsløvvej 15, 5000, Odense, Denmark; Institute of Clinical Research, University of Southern, J.B Winsløvvej 19.3, 5000 Odense Denmark.
| | - C Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern, Sygehusvej 24, 6000 Kolding Denmark; Institute of Regional Health Research, University of Southern, J.B Winsløvvej 19.3, 5000 Odense Denmark
| | - M S Larsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B Winsløvvej 15, 5000, Odense, Denmark; Institute of Clinical Research, University of Southern, J.B Winsløvvej 19.3, 5000 Odense Denmark
| | - F Damborg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern, Sygehusvej 24, 6000 Kolding Denmark
| | - B Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern, Sygehusvej 24, 6000 Kolding Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B Winsløvvej 15, 5000, Odense, Denmark; Institute of Regional Health Research, University of Southern, J.B Winsløvvej 19.3, 5000 Odense Denmark
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Fletcher AN, Mody KS, Adams SB, DeOrio JK, Easley ME, Nunley JA. Effect of Gender Differences on Patient-Reported Outcomes and Complications in Total Ankle Replacement. Foot Ankle Int 2021; 42:776-787. [PMID: 33517772 DOI: 10.1177/1071100720985292] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate gender differences in patient outcomes and complications following total ankle replacement (TAR). METHODS Consecutive patients who underwent primary TAR from July 2007 through May 2016 were prospectively followed and retrospectively reviewed. Demographic, operative, patient-reported outcomes (PROs), and complication data were collected and analyzed. PROs included the visual analog scale (VAS), 36-Item Short-Form Health Survey (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Short Musculoskeletal Function Assessment (SMFA). A total of 475 patients were evaluated, including 248 males (52.2%) and 227 females (47.8%) with an average of 56.8 months follow-up. RESULTS Women were more likely to have inflammatory arthritis (13.7% vs 2.8%; P < .01) and significantly worse preoperative SF-36 total, SF-36 mental health component, AOFAS total, AOFAS pain, SMFA function, and SMFA bother scores (all P < .05). Both genders demonstrated significant improvement in PROs at 1, 2, and 5 years. The magnitude of improvement was similar between genders for all PROs (all P < .05) with the exception of SF-36 physical function, which was greater in men. Females underwent more nonrevision reoperations (32.2% vs 22.6%; P = .0191), but there was no significant difference in failure rates (male 7.3% vs female 3.5%; P = .07). The reoperation and failure rates at 2 years postoperation were 10.1% and 1.6% for men and 18.5% and 0.9% for women, respectively. CONCLUSION Women undergoing TAR were more likely to have worse preoperative PROs and higher rates of nonrevision reoperations, which remains true when controlling for their increased incidence of inflammatory arthritis. However, women reported similar improvements in PROs and had similar prosthetic survival rates as men. Increased understanding of these disparities, combined with gender-based interventions, may further advance patient outcomes. LEVEL OF EVIDENCE Level III, therapeutic, retrospective comparative series.
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Affiliation(s)
- Amanda N Fletcher
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - Kush S Mody
- Drexel University College of Medicine & Columbia Business School, Philadelphia, PA, USA
| | - Samuel B Adams
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - James K DeOrio
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - Mark E Easley
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - James A Nunley
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
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Simonsen MB, Hørslev-Petersen K, Cöster MC, Jensen C, Bremander A. Foot and Ankle Problems in Patients With Rheumatoid Arthritis in 2019: Still an Important Issue. ACR Open Rheumatol 2021; 3:396-402. [PMID: 33943043 PMCID: PMC8207681 DOI: 10.1002/acr2.11258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To study the prevalence of foot pain in patients with rheumatoid arthritis (RA) and whether including a 12‐joint foot count in addition to the 28‐joint count (from the Disease Activity Score 28 [DAS28]) improved detection of foot or ankle pain. In addition, the association between the self‐reported foot and ankle score (SEFAS), patient‐reported function, and disease‐specific factors was studied. Methods Physician‐reported data (swollen/tender 12‐joint foot count, DAS28, and medication) and patient‐reported data (foot/ankle pain, physical function, global health, and SEFAS) were assessed during a clinical visit. Data were analyzed with t test, χ2 tests, and regression analysis. Results A total of 320 patients with RA were included (mean age 63 years, SD 13 years; 73% women), of whom 69% reported foot or ankle pain. Patients who reported foot or ankle pain had a lower mean age and worse disease activity, general pain, function, and global health (P ≤ 0.016), and fewer were in remission (50% versus 75%; P < 0.001) compared with patients without foot pain. The 12‐joint foot count identified 3.2% and 9.5% additional patients with swollen and tender joints, respectively, compared with the 28‐joint count. The SEFAS was associated with walking problems (β = −2.733; 95% confidence interval [CI] = −3.963 to −1.503) and worse function (β = −3.634; 95% CI = −5.681 to −1.587) but not with joint inflammation severity. Conclusion The prevalence of foot or ankle pain in patients with RA is high. The 12‐joint foot count had minor effects on detecting patients with foot pain. However, the SEFAS contributed additional information on foot problems that was not identified by joint examinations alone.
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Affiliation(s)
- Morten Bilde Simonsen
- Aalborg University, Aalborg, Denmark, and North Denmark Regional Hospital, Hjoerring, Denmark
| | | | | | - Carsten Jensen
- Hospital Lillebaelt, Kolding, Denmark, and University of Southern Denmark, Odense, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark, and University of Southern Denmark, Odense, Denmark, and Lund University, Lund, Sweden
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Pilskog K, Gote TB, Odland HEJ, Fjeldsgaard KA, Dale H, Inderhaug E, Fevang JM. Traditional Approach vs Posterior Approach for Ankle Fractures Involving the Posterior Malleolus. Foot Ankle Int 2021; 42:389-399. [PMID: 33203272 PMCID: PMC8054166 DOI: 10.1177/1071100720969431] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the past, posterior malleolus fragments (PMFs) commonly have been indirectly reduced and fixed when fragments involve 25% or more of the tibial articular surface, while smaller fragments were left unfixed. The posterior approach has become increasingly popular and allows fixation of even smaller fragments. This study compares clinical outcome for the 2 treatment strategies. METHODS Patients with ankle fractures involving a PMF treated from 2014 to 2016 were eligible for inclusion. Patients were allocated to group A (treated with a posterior approach) or group B (treated with the traditional approach) according to the treatment given. A one-to-one matching of patients from each group based on the size of the PMF was performed. Patient charts were reviewed, and outcome evaluation was performed clinically, radiographically, and by patient-reported outcome measures (PROMs; Self-Reported Foot and Ankle Score, RAND-36, visual analog scale [VAS] of pain, and VAS of satisfaction). Forty-three patients from each group were matched. Median follow-up was 26 (interquartile range [IQR], 19-35) months postoperatively. RESULTS The median PMF size was 17% (IQR, 12-24) in both groups, and they reported similar results in terms of PROMs. Fixation of the PMF was performed in 42 of 43 (98%) patients in group A and 7 of 43 (16%) patients in group B (P < .001). The former group more frequently got temporary external fixation (56% vs 12%, P < .01) and less frequently had syndesmotic fixation (14% vs 49%, P < .01), and they had less mechanical irritation and hardware removal but more noninfectious skin problems (28% vs 5%, P < .01). Median time from injury to definitive surgery (8 vs 0 days, P < .001) and median length of stay (12 vs 3 days, P < .001) were longer in group A. CONCLUSION Comparison of treatment strategies for ankle fractures involving the posterior malleolus showed similar results between patients treated with a traditional approach and a posterior approach. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Kristian Pilskog
- Orthopedic Department, Haukeland
University Hospital, Bergen, Norway,Kristian Pilskog, MD, Orthopedic Department,
Haukeland University Hospital, Postbox 1400, 5021, Bergen, Norway.
| | - Teresa Brnic Gote
- Department of Physiotherapy, Haukeland
University Hospital, Bergen, Norway
| | | | | | - Håvard Dale
- Orthopedic Department, Haukeland
University Hospital, Bergen, Norway
| | - Eivind Inderhaug
- Orthopedic Department, Haukeland
University Hospital, Bergen, Norway
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Cöster ME, Montgomery F, Cöster MC. Patient-reported outcomes of joint-preserving surgery for moderate hallux rigidus: a 1-year follow-up of 296 patients from Swefoot. Acta Orthop 2021; 92:109-113. [PMID: 32972279 PMCID: PMC7919882 DOI: 10.1080/17453674.2020.1824762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hallux rigidus (HR) may cause decreased range of motion, joint pain, and gait disturbances. There is a lack of evidence regarding the outcome of different surgical procedures for moderate HR. We report patient-reported outcomes after joint-preserving surgical procedures for moderate HR.Patients and methods - We included 296 patients registered in Swefoot (Swedish national registry of foot and ankle surgery) who underwent primary surgery for moderate HR 2014 through 2018. We extracted information on anthropometrics, grading of HR, chosen surgical procedure, and patient-reported data including the PROMs SEFAS (summary score 0-48) and EQ-5D-3L (index 0-1) preoperatively and 1 year postoperatively.Results - 115 patients underwent metatarsal decompression (i.e., Youngswick) osteotomy (YOT) and 181 underwent cheilectomy. The mean improvement in SEFAS score 1 year after surgery was 12 points (95% CI 10 - 13) for YOT and 10 points (CI 9 - 12) for cheilectomy. Also, EQ-5D improved in both groups. Patients who underwent YOT were more satisfied with the procedure (84% vs. 70% for cheilectomy, p = 0.02).Interpretation - Surgically treated patients with moderate HR improved after both YOT and cheilectomy, according to patient-reported data from Swefoot. Patients who underwent a YOT were more satisfied with their procedure. One possible explanation may be that more patients in the YOT group had a concomitant hallux valgus; however, we have no information on this.
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Affiliation(s)
- Marcus E Cöster
- Department of Clinical Sciences, Lund University; ,Department of Orthopedics, Central Hospital in Växjö; ,Correspondence:
| | | | - Maria C Cöster
- Department of Clinical Sciences, Lund University; ,Department of Orthopedics, Skåne University Hospital in Malmö, Sweden
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Whittaker GA, Munteanu SE, Roddy E, Menz HB. Measures of Foot Pain, Foot Function, and General Foot Health. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:294-320. [PMID: 33091250 DOI: 10.1002/acr.24208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/02/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Glen A Whittaker
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, Chesterfield, UK, School of Primary, Community and Social Care, Keele University, Keele, UK, and Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Hörterer H, Baumbach SF, Lemperle S, Altenberger S, Gottschalk O, Mehlhorn AT, Röser A, Walther M. Clinical outcome and concomitant injuries in operatively treated fractures of the lateral process of the talus. BMC Musculoskelet Disord 2019; 20:219. [PMID: 31092241 PMCID: PMC6521553 DOI: 10.1186/s12891-019-2603-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this study was to review the patient rated outcome (PROM) of surgically treated fractures to the lateral process of the talus (LPTF) and identify factors influencing the outcome. Methods Retrospective study with a current follow-up. Eligible were all patients treated surgically for a LPTF (n = 23) with a minimum follow-up of one year. Demographics, medical history, trauma mechanism, fracture characteristics, concomitant injuries, treatment details, complications, return to work and sports were assessed retrospectively. The current follow-up included the VAS FA, Karlsson Score, and SF-12. The primary outcome was the VAS FA. Secondary aim was the identification of parameters influencing the PROMs. Results 22 patients (96% follow-up) with a mean age of 32 ± 9 (18 to 49) years were included. 73% suffered a Hawkins Type 1, 23% a Type 2, and one patient a Type 3 fracture. 82% suffered concomitant injuries. 9% suffered minor surgical side infections, 50% developed symptomatic subtalar osteoarthritis. At final follow-up (44 ± 2 (12 to 97) months), the mean VAS FA Overall was 77 ± 21 (20 to 100), the Karlsson Score 72 ± 21 (34 to 97), and for the SF 12 the PCS 53 ± 8 (36 to 64) and the MCS 53 ± 7 (32 to 63). 50% of patients returned to their previous level of sports. Hawkins Type 1 fractures resulted in better VAS FA Overall score than Type 2 fractures. Posttraumatic subtalar osteoarthritis was the independent factor associated to a poor patient rated outcome (VAS FA, Karlsson Score). Conclusion After a follow-up of over 3.5 years, surgically treated LPTF resulted in only moderate results. 50% suffered posttraumatic symptomatic subtalar osteoarthritis, which was the primary independent parameter for a poor outcome following LPTF. Level of evidence Level III. Electronic supplementary material The online version of this article (10.1186/s12891-019-2603-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hubert Hörterer
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Germany. .,Department of General, Trauma, and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany.
| | - Sebastian Felix Baumbach
- Department of General, Trauma, and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Lemperle
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Germany
| | - Sebastian Altenberger
- Center for Foot and Ankle Surgery, Schön Klinik Bad Aibling Harthausen, Bad Aibling, Germany
| | - Oliver Gottschalk
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Germany.,Department of General, Trauma, and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Tobias Mehlhorn
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Germany.,Department of Trauma and Orthopedic Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Anke Röser
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Germany
| | - Markus Walther
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Germany.,Department of Orthopedics and Orthopedic Surgery, Julius-Maximilians-University, Würzburg, Germany
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