Mobility Limitation is Greater After Surgery for Degenerative Pathology of the Ankle, Hindfoot, and Midfoot than Total Hip Arthroplasty

Abstract

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Degenerative conditions of the ankle, hindfoot, and midfoot can markedly limit mobility. Surgery often results in lengthy postoperative recoveries with requisite weight-bearing restrictions. In contrast, total hip arthroplasty (THA) is associated with fewer postoperative restrictions and quicker recovery of mobility. In this study, we utilized the Life-Space Assessment (LSA), a questionnaire quantifying how patients mobilize after a medical event as they return to previous daily settings. The LSA has never previously been utilized to describe the perioperative mobility of patients undergoing THA or elective foot and ankle surgery. Current outcome measures do not accurately assess patient mobility in the geriatric foot and ankle or THA populations. We hypothesize that patients undergoing elective foot and ankle surgery will have greater postoperative mobility limitation than THA patients. Methods: Preoperative, 3-month postoperative, and 6-month postoperative LSA data was collected from both the THA and foot and ankle cohorts. 12-month postoperative data was obtained for the foot and ankle group but was unavailable for the THA cohort. The degenerative foot and ankle cohort included patients undergoing surgery for Achilles tendonitis, ankle joint cartilage defects, ankle arthritis, subtalar arthritis, and midfoot arthritis. Patient demographics and comorbidities were recorded from the electronic medical record. Data was analyzed using a Student’s t-test. Results: 28 foot and ankle and 35 THA patients met inclusion criteria. Demographics were not significantly different between the groups. Mean preoperative foot and ankle LSA (62) was lower than the THA score (72.2), although not a significant difference (p=0.246). THA LSA scores improved 3-months postoperatively (85) compared to preoperative (p=0.09). At 3-months, foot and ankle scores were less (45.1) compared to both preoperative baseline and 3-month THA (p=0.22, p=0.0013). At 6-months, the THA group improved to 91, whereas the foot and ankle group increased to 65.5 (p=0.0281). THA patients showed an increase from preoperatively (72) to 6-months postoperative (91) (p=0.008); however, foot and ankle patients showed no difference (62 to 65.5, p=0.82). 12-months postoperatively, foot and ankle patients showed improvement (85.7) compared to preoperative (p=0.09). Conclusion: Degenerative conditions of the ankle, hindfoot, and midfoot may have greater limitation on mobility compared to hip osteoarthritis. Recovery of mobility after surgery for degenerative foot and ankle conditions is slower with lower mobility at 3 months and likely 6 months postoperatively compared to total hip arthroplasty. At 6 months postoperatively, total hip arthroplasty patients exhibit improved mobility compared to their preoperative state, whereas patients undergoing surgery for degenerative ankle, hindfoot, and midfoot diagnoses do not show improved mobility until 12-months postoperatively.