Preoperative PROMIS Physical Function Scores Predict Postoperative Outcomes Following Total Ankle Replacement

Abstract

Background: Despite good evidence that supports significant improvements in pain and physical function following a total ankle replacement (TAR) for end-stage ankle arthritis, there is a subset of patients who do not significantly benefit from surgery. The purpose of this study was to perform a preliminary analysis to determine if preoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores could be used to predict which patients were at risk of not meaningfully improving following a TAR. Methods: Prospectively collected preoperative and ≥2-year postoperative PROMIS physical function, pain interference, pain intensity, and depression scores for 111 feet in 105 patients were included in the study. Significant postoperative improvement was defined using minimal clinically important differences (MCIDs). Logistic regression models and area under the curve (AUC) analyses were used to determine whether preoperative PROMIS scores were predictive of postoperative outcomes. Results: Receiver operating characteristic curves found statistically significant AUCs for the PROMIS physical function (AUC = 0.728, P = .004), pain intensity (AUC = 0.720, P = .018), and depression (AUC = 0.761, P < .001) domains. The preoperative PROMIS pain interference domain did not achieve a statistically significant AUC. Conclusion: Preoperative PROMIS physical function and pain intensity t scores may be used to predict postoperative improvement in patients following a fixed-bearing TAR; however, preoperative PROMIS pain interference scores were not good predictors. The results of this study may be used to guide research regarding patient-reported outcomes following TAR. Level of Evidence: Level III, retrospective comparative series.

Early Radiographic and Clinical Outcomes of a Novel, Fixed-Bearing Fourth-Generation Total Ankle Replacement System

“…8,23 However, PROMIS has been shown to be associated with postoperative outcomes in TAA patients, and more reliable, responsive, and efficient than the Foot and Ankle Ability Measure activities of daily living, which adds to the strength of our study. 5,18 When comparing the amount of improvement to previously published minimal clinically important differences, 20 we find that our cohort demonstrated clinically significant improvement in PROMIS physical function and pain interference. The lack of improvement in PROMIS Depression suggests that the pain caused by ankle arthritis and the pain relief from TAA may not affect emotional well-being.…”

Relationship Between Preoperative PROMIS Scores and Postoperative Outcomes in Hallux Rigidus Patients Undergoing Cheilectomy

“…Although some PROMIS item banks administered by CAT have been validated for use in foot and ankle patients, and preoperative PROMIS has been shown to be associated with postoperative outcomes in other pathologies such as progressive collapsing foot deformity, total ankle replacement (TAR), and hallux valgus, the disability and pain from hallux rigidus in the patients we operated on may not have been identified by the PROMIS questionnaires we used. 1,3,4,8,10,13…”

“…Finally, posttest probabilities were calculated for LRs that were found to be statistically significant. 3 All analyses were conducted on R: A language and Environment for Statistical Computing (R Core Team 2021, Vienna, Austria).…”

“…1,8 Prior studies have also shown that preoperative PROMIS scores are associated with postoperative improvement in hallux valgus, progres sive collapsing foot deformity, and endstage ankle arthri tis. 3,4,13 However, no studies have investigated whether preoperative PROMIS scores are associated with postoper ative outcomes following a cheilectomy for hallux rigidus.…”

Contemporary Review: An Overview of the Utility of Patient-Reported Outcome Measurement Information System (PROMIS) in Foot and Ankle Surgery

“…In a separate study, preoperative PROMIS PF and PIs (Pain Intensity) scores were indicative of which patients would achieve MCID following TAA. 10 Before any meaningful conclusions can be drawn, validation studies of PROMIS in the TAA population are first required. Although PROMIS has not yet been validated for patients undergoing reconstruction for adult acquired flatfoot deformity (AAFD), there are data regarding PROMIS's responsiveness in these patients.…”