Relationship of Preoperative Patient-Reported Outcome Measures (PROMs) to Postoperative Success in End-Stage Ankle Arthritis

Abstract

Background: Ankle osteoarthritis is a significant cause of pain and disability. Despite the effectiveness of treatments, a subset of patients remains with persistent pain and functional limitations. The purpose of this study was to use preoperative patient-reported outcome measures to predict which ankle osteoarthritis patients would be most likely to experience postoperative improvements in functional outcomes. Methods: A retrospective analysis of prospectively collected data was used to evaluate 427 patients with end-stage ankle arthritis with 5-year follow-up. Demographics, comorbidities, Ankle Osteoarthritis Scale (AOS), Ankle Arthritis Score (AAS), and the physical and mental component scores of the Short Form–36 (SF-36 Physical Components Score [PCS] and Mental Components Score [MCS]) were collected. The minimal clinically important difference (MCID) was then calculated. Receiver operating characteristic (ROC) analysis was used to choose the optimal threshold values of preoperative patient-reported outcome measure and assess the prediction performance. Results: Patients who scored worst at preoperative baseline made the greatest gains in function and pain relief, and they had a high chance of achieving MCID following surgical treatment. ROC curves demonstrated that preoperative AOS, AAS, and SF-36 PCS and MCS scores were predictive of postoperative improvements in physical and mental function. Patients with preoperative AOS score above 45.7 had an 83% probability of achieving an MCID (AUC = 0.67). Similarly, patients with a preoperative AAS score above 25.7 had a 78% probability of achieving an MCID (AUC = 0.63). Patients with a preoperative SF-36 PCS score below 31 had a 62% probability of achieving an MCID (AUC = 0.64). Patients with a preoperative SF-36 MCS below 52.7 had a 47% probability of achieving an MCID (AUC = 0.89). MCIDs for AOS, AAS, SF3-36 PCS, and SF-36 MCS score changes were 12.4, 10.0, 6.43, and 8.1, respectively. Conclusion: Preoperative patient-reported outcomes measures could predict postoperative improvement in ankle arthritis patients. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected benefit of surgery. Level of Evidence: Level III, prognostic comparative study.

Preoperative Patient-Reported Outcome Measures Relationship With Postoperative Outcomes in Flexible Adult-Acquired Flatfoot Deformity

“…Previous studies have used PROs to determine specific preoperative thresholds for achieving the MCID in foot and ankle surgery. 1,11,16,21 Ho et al 11 included 61 patients who underwent a variety of foot and ankle orthopedic procedures, including Achilles debridement, ankle arthroscopy, flatfoot correction, lateral ligament reconstruction, and bunionectomy. At an average follow-up of 9.9 months (range, 7.3-12.8 months), they reported a mean postoperative improvement of 8.4 and 3.9 in PROMIS PF and PI, respectively, and found that patients were likely to meet the MCID after surgery if their preoperative PROMIS PF was less than 29.7 and were unlikely to improve if their preoperative PROMIS PF was greater than 42.…”

Effect of Patient Demographics on Minimally Important Difference of Ankle Osteoarthritis Scale Among End-Stage Ankle Arthritis Patients

“…2,21,39 Patients who fail conservative treatment of their ESAA are most commonly treated with either ankle arthrodesis (AA) or total ankle replacement (TAR). 14,32,40,42 AA is often recommended for younger Foot & Ankle International 00(0) and more active, high-demand patients or patients with comorbidities compromising soft-tissue healing 32,44 and TAR is often recommended for patients aged 65 years or older with lower demands. 44 TAR has become increasingly popular 35 and has been found to be more cost-efficient than AA among both older and younger patients.…”

“…14,32,40,42 AA is often recommended for younger Foot & Ankle International 00(0) and more active, high-demand patients or patients with comorbidities compromising soft-tissue healing 32,44 and TAR is often recommended for patients aged 65 years or older with lower demands. 44 TAR has become increasingly popular 35 and has been found to be more cost-efficient than AA among both older and younger patients. 12,34 To measure health-related quality of life, symptoms, and functioning from the patient's perspective, patient-reported outcomes (PROs) are increasingly being used.…”

“…With repeated application of PROs, changes in patients' health status, symptoms, or function, including before and after surgery 5,27 can be measured. PROs, including the Ankle Osteoarthritis Scale (AOS), 19,29 have become widely used for reporting patients' perspectives of their foot and ankle-related health, 19,21,29,36,39,41,44 including among ESAA patients throughout the perioperative period. 14,36,41 Among the PRO literature, the minimal important difference (MID)-sometimes referred to as the minimal clinically important difference (MCID)-is the smallest amount of change in PRO value that a patient considers to be meaningful.…”

“… 8 Another reported the MID as 12.35 at an average follow-up of 5 years postoperation. 44 Although estimated at different points in time, the disparity between the MIDs is large, a 50% difference, though no evidence of a time-related “decay” in the MID has been reported, and the contrast leaves clinicians and interventionists without a definitive approach to reconciling the MID for AA or TAR.…”