Outcomes of Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity in Older Patients

Conti, Matthew S.; Jones, Mackenzie T.; Savenkov, Oleksandr; Deland, Jonathan T.; Ellis, Scott J.

doi:10.1177/1071100718777459

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…PROs have been reported extensively in the literature for measuring effectiveness of hip and knee arthroplasty, though their application is less common or standardized for measuring ankle function or effectiveness of ankle interventions. 9,10,27,40…”

Section: Introductionmentioning

confidence: 99%

Health and Quality of Life Outcomes Among Patients Undergoing Surgery for End-Stage Ankle Arthritis

et al. 2019

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Background:There is little research investigating which aspects of health-related quality of life change following ankle arthrodesis and total ankle replacement surgery. The objective of this study was to report on statistically and clinically relevant changes in multiple dimensions of health-related quality of life among patients undergoing ankle replacement or fusion surgery.Methods:This study was based on a prospective sample of ankle arthrodesis and total ankle replacement patients. Participants complete the Ankle Osteoarthritis Scale, EuroQoL’s EQ-5D-3L, the Patient Health Questionnaire–9, and the pain intensity, interference with enjoyment of life, and general activity pain instrument. Instruments were completed preoperatively and postoperatively. Multivariate regression models were used to measure the change in health-related quality of life outcomes, adjusting for demographic, clinical, and health service utilization.Results:Participants achieved statistically significant improvements in health-related quality of life in each domain of measurement. The majority of participants reported clinically significant improvement in pain. Mild depressive symptoms were common, and clinically significant improvement in depression symptoms occurred in 22% of patients. Gains in health were more pronounced among participants reporting the worst preoperative health in all domains quality of life measured.Conclusions:Pain showed a clinically important improvement among 64% of participants whereas 22% reported a clinically meaningful improvement in their depression symptoms postoperatively. Clinically significant gains in health-related quality of life were not experienced by all participants in all dimensions. Further research is warranted to better understand the failure of some patients to improve in dimensions of health studied.Level of Evidence:Level III, comparative study.

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Section: Introductionmentioning

confidence: 99%

Health and Quality of Life Outcomes Among Patients Undergoing Surgery for End-Stage Ankle Arthritis

et al. 2019

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“…17,30,33,43 A previous study by Conti et al reported clinical outcomes in patients aged <45 years as a “younger” cohort, and they found no significant differences in clinical outcomes or subsequent surgeries between their older and younger cohorts. 10 However, we looked at young adults aged ≤30 years.…”

Section: Discussionmentioning

confidence: 99%

“…This observation is consistent with previous findings in which patients less than 45 years old had a lower incidence of revision surgery when compared to patients older than 45 years. 10 The authors hypothesize that this may be attributed to the general ability for these younger patients to adapt and compensate more than older patients in the setting of under- or overcorrection. Younger patients with better bone quality also likely heal better than their older counterparts.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Idiopathic Flexible Flatfoot Deformity Reconstruction in the Young Patient

Day

Conti

Williams

et al. 2020

Foot & Ankle Orthopaedics

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Background: Operative correction of flatfoot deformity has been well studied in the older population. There is a subset of younger patients without congenital foot deformity that also develop a collapsing flatfoot. However, assessment of outcomes across age groups is limited, especially in the young demographic. The purpose of our study was to compare operative outcomes of flatfoot reconstruction between these 2 age groups. Methods: Seventy-six feet (41 left, 35 right) in 71 patients who underwent flexible flatfoot reconstruction were divided into 2 groups based on age: ≤30 years (n = 22) and >30 years (n = 54). Exclusion criteria included congenital causes of flatfoot (tarsal coalition, vertical talus, overcorrected clubfoot). Average age was 20.8 years (range, 14-30) and 55.4 years (range, 35-74) in the younger and older cohorts, respectively. Preoperative and minimum 2-year postoperative Patient-Reported Outcomes Measurement Information Systems (PROMIS) scores were compared. Five radiographic parameters were assessed pre- and postoperatively: talonavicular coverage angle, lateral talo–first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, and hindfoot moment arm. Procedures performed and incidence of minor (removal of symptomatic hardware) and major (revision) reoperations were compared. Results: Younger patients were less likely to undergo flexor digitorum longus transfer, first tarsometatarsal fusion, spring ligament repair, and posterior tibial tendon repair (all P < .05). Both younger and older cohorts demonstrated significant improvement in multiple PROMIS domains at an average follow-up of 30.6 (range, 24-44) and 26.8 (range, 24-45) months, respectively ( P = .07). Younger patients demonstrated significantly higher pre- and postoperative Physical Function (mean difference postoperatively, 4.6; 95% confidence interval, 1.5-7.8; P = .03). There were no differences in radiographic parameters postoperatively. There were 8 (36.4%) reoperations (all minor) in the younger group, and 21 (38.9%) reoperations (6 major, 15 minor) in the older group ( P = .84). Conclusion: Our data suggest that age may play a role in clinical outcomes, procedures indicated, and subsequent corrective reoperations. Younger patients maintained greater physical function with comparable radiographic correction, with less frequent indication for tendon transfers, arthrodesis, and additional corrective surgeries. Level of Evidence: Level III, retrospective comparative study.

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“…5 Post hoc analysis in this study demonstrated that the value of 6 was consistently between 2 thresholds used to estimate the MCID: one-half the standard deviation and the standard error of the mean. 7,24…”

Section: Methodsmentioning

confidence: 99%

Fulfillment of Expectations After Orthopedic Foot and Ankle Surgery

et al. 2019

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Background: To date, no study has assessed fulfillment of patients’ expectations after foot and ankle surgery. This study aimed to validate a method of assessing expectation fulfillment in foot/ankle patients postoperatively. Methods: Preoperatively, patients completed the expectations survey, consisting of 23 questions for domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. The FP ranges from 0 (no expectations fulfilled), to between 0 and 1 (expectations partially fulfilled), to 1 (expectations met), to greater than 1 (expectations surpassed). Receiver operating characteristic (ROC) curves and areas under the curve (AUCs) with 95% confidence intervals (CIs) were used to compare the expectations survey to other outcome surveys, including Foot and Ankle Outcome Score, improvement, overall fulfillment, Delighted-Terrible scale, and satisfaction. Results: Of the 271 patients (mean age 55.4 years, mean BMI 27.5, 65% female), 34% had expectations surpassed (FP >1), 4% had expectations met, 58% had expectations partially fulfilled (FP between 0 and 1), and 5% had no expectations met. The mean FP was 0.84 ± 0.41 (range 0-3.13), indicating partially fulfilled expectations. FP correlated significantly with all outcome measures ( P ≤ .007). FP was associated most closely with satisfaction ( r = 0.66 [95% CI 0.57-0.75]; AUC = 0.92 [95% CI 0.88-0.96]; P < .001) and improvement ( r = 0.73 [95% CI 0.64-0.81]; AUC = 0.94 [95% CI 0.91-0.96]; P < .001). Based on the associations with satisfaction and improvement outcomes, a clinically important proportion of expectations fulfilled is 0.68, with sensitivity 0.85-0.90 and specificity 0.84-0.86. Conclusion: The proportion of expectations fulfilled is a novel patient-centered outcome that correlated with validated outcome measures. The expectations survey may be used by surgeons to counsel patients preoperatively and also to assess patients’ results postoperatively. Level of Evidence: Level II, prospective comparative series.

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Outcomes of Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity in Older Patients

Cited by 24 publications

References 18 publications

Health and Quality of Life Outcomes Among Patients Undergoing Surgery for End-Stage Ankle Arthritis

Health and Quality of Life Outcomes Among Patients Undergoing Surgery for End-Stage Ankle Arthritis

Outcomes of Idiopathic Flexible Flatfoot Deformity Reconstruction in the Young Patient

Fulfillment of Expectations After Orthopedic Foot and Ankle Surgery

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