Abstract
BackgroundResearch 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.MethodsThis 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.ResultsThe 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.ConclusionAverage 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 evidenceLevel II, prospective single cohort study.
Highlights
Ankle arthrodesis remains the most commonly performed surgical procedure for end-stage osteoarthritis of the tibiotalar joint [27]
The purpose of this study was to determine the temporal change in patient reported outcome measures using the validated patient reported outcome measurement information system (PROMIS) [10,11,12,13,14, 19] T-score for patients undergoing ankle arthrodesis for primary ankle arthritis
Data were identified for 88 patients after ankle arthrodesis with at least one preoperative and one postoperative PROMIS Physical function (PF) and pain interference (PI) T-scores performed during the study timeframe
Summary
Ankle arthrodesis remains the most commonly performed surgical procedure for end-stage osteoarthritis of the tibiotalar joint [27]. Functional outcome scores after undergoing ankle arthrodesis show improvement from pre- to postoperative scores The majority of these results are based on questionnaires that focus on pain and disability in activities of daily living and on non-validated patient reported outcome measures like the American Orthopaedic Foot and Ankle Society (AOFAS) score [3, 5, 16, 17, 20, 26, 29]. These questionnaires focus on basic functional outcomes such as walking and stairclimbing and are specific to foot and ankle function, not to a patient’s general health status or ability level. 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
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