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

Abstract

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.

Overall Health and the Influence of Physical Therapy on Physical Function Following Total Ankle Arthroplasty

“…In contrast, prior investigations have reported that referral to nursing or rehabilitation facilities following TAA approached 20%, and that PT use following TAA approached 10%. 3,30 However, Rajapakshe et al 30 acknowledged that PT use following TAA in their study was likely underestimated. To this point, nearly 90% of our sample received several PT visits (Table 2).…”

“…11,18,28 Relatively few studies have considered overall health or multiple domains of health. 23,24,30,34,35 One option to efficiently characterize patient health status is the Patient-Reported Measurement Information System (PROMIS). In reflection of the biopsychosocial model of care, PROMIS outcome measures include multiple domains of health to provide person-centered assessments of function (physical), symptoms (psychological), and social impact, which can be compared to population mean values.…”

Osteoartrite do tornozelo

“…É possível indicar o procedimento para pacientes com OA grave sem o perfil descrito previamente, mas nesse cenário as taxas de complicações como infecção, deiscência, dor residual, amplitude de movimento reduzida e taxas de reoperação são elevadas. [59][60][61] São contraindicações absolutas à artroplastia total do tornozelo (ATT):…”

“…As vias de acesso possíveis são via anterior ou lateral transfibular. [59][60][61] Os estudos com ATT revelam melhora clínica e dos escores de dor em até 64% dos casos. A ATT com o uso dos implantes mais modernos mostra taxas de sucesso de 70 a 90% em 10 anos.…”

“…A ATT com o uso dos implantes mais modernos mostra taxas de sucesso de 70 a 90% em 10 anos. Idade, índice de massa corporal (IMC) e grau da deformidade pré-operatória não estão associados a maiores taxas de falha, porém pacientes com artrodese do retropé apresentaram risco significativamente maior de falha dos implantes (►Figura 1) [59][60][61][62] Estágio IV. Artrodese -Principalmente indicada para pacientes com osteoartrite grave, na falha das opções anteriores, associada a elevada limitação funcional, secundária a qualquer etiologia, e em qualquer faixa etária.…”