Impact of Resilience on Patient Reported Outcome of First Metatarsophalangeal Arthrodesis

Resilience is a dynamic construct defined as the ability to recover from stress. There is no literature examining the impact of resilience on outcomes following foot and ankle surgery. Retrospective analysis of patients who underwent first MTP arthrodesis from September 2011 to May 2020 were reviewed for patient characteristics and union status. PROMIS Physical Function (PF), Pain Interference (PI), Depression (D), and Foot Function Index (FFI) were collected. Resilience was measured using the Brief Resilience Scale. A multivariable linear regression analysis examining the impact of resilience on patient reported was conducted. At an average of 3.4 years postoperatively, resilience was found to independently affect patient reported outcomes across all instruments, except the FFI pain subscale. In the first study examining the impact of resilience following foot and ankle surgery, we found that resilience has an independent positive effect on overall physical function, disability, pain, and mental health following MTP arthrodesis. Preoperative resilience scores could be used to predict postoperative functional outcomes following MTP arthrodesis and guide postoperative rehabilitation. These findings help establish the role of early positive psychosocial characteristics within orthopaedic foot and ankle population.</jats:p

Impact of Resilience on Patient Reported Outcomes of First Metatarsophalangeal Arthrodesis

Category: Other; Ankle; Midfoot/Forefoot Introduction/Purpose: Resilience is an interactive dynamic construct most simply defined as the ability to recover from stress. To date, there is no literature examining the impact of resilience on the outcomes following foot and ankle surgery. Methods: We retrospectively reviewed patients who underwent first MTP arthrodesis from September 2011 to May 2020, 98 met inclusion criteria. Medical records were reviewed for patient characteristics and union status. PROMIS Physical Function (PF), Pain Interference (PI), Depression (D), and the Foot Function Index (FFI) were collected. Resilience was measured using the Brief Resilience Scale. A multivariable linear regression analysis examining the impact of resilience on patient reported outcomes while adjusting for potential confounding covariates was conducted. Results: At an average of 3.4+-2.6 (SD) years postoperatively, resilience was found to have an independent effect on patient reported outcomes across all instruments, except the FFI pain subscale. Resilience's effect on the instruments was as follows: PROMIS physical function (Unstandardized β 5.0, 95% CI 2.6 to 7.4), PROMIS pain interference (Unstandardized β -4.8, 95% CI - 7.8 to -1.8), PROMIS Depression (Unstandardized β -9.4, (95% CI -12.8 to -6.1), FFI disability subscale (Unstandardized beta -13.3, 95% CI -20.3 to -6.3 ), FFI activity limitation subscale (Unstandardized beta -15.7, 95% CI -23.0 to -8.5), FFI total (Unstandardized beta -11.7, 95% CI -18.1 to -5.4), and FFI pain subscale (Unstandardized beta -6.5, 95% CI -13.1 to.01). Conclusion: In this first study examining the impact of resilience following foot and ankle surgery, we found that resilience has an independent positive effect on overall physical function, disability, pain, and mental health following MTP arthrodesis. Preoperative resilience scores could be used to predict postoperative functional outcomes following MTP arthrodesis and guide postoperative rehabilitation. These findings help establish the role of early positive psychosocial characteristics within orthopaedic foot and ankle population. </jats:sec

Outcomes of Tibiocalcaneal Arthrodesis in High Risk Patients: An Institutional Cohort of 18 Patients

Category: Hindfoot Introduction/Purpose: Tibiocalcaneal (TC) arthrodesis is commonly performed in patients with severe hindfoot disease. These include severe Charcot deformities, ankle malformations, chronic osteomyelitis (COM), and avascular necrosis (AVN). The talar vasculature becomes disrupted to the point that the bone can no longer be salvaged. The procedure involves performing a talectomy and fusing the tibia to the calcaneus. This helps in preserving the remaining hindfoot anatomy while allowing the patient to regain function and mobility. Our study highlights certain risk factors that influence the rate of postoperative complication after tibiocalcaneal surgery. Methods: We retrospectively reviewed the charts of 18 patients from a single institution who underwent tibiocalcaneal arthrodesis between the years of 2011 and 2019. Preoperative diagnoses, comorbidities, post-operative outcomes were noted among all patients. Then, the rates of non-union, below-knee amputations, revision surgeries, postoperative infections, and hardware failure were recorded. This data was then analyzed to determine which preoperative and perioperative factors affected postoperative outcomes for patients after tibiocalcaneal arthrodesis surgery. Results: Nonunion was the most commonly reported complication in this series. Eight of the eighteen patients were documented to have nonunion including three patients with stable pseudarthrosis. Diabetic patients had a slightly higher incidence of nonunion (4 of 7 patients) compared to those without diabetes (4 of 11 patients). Of the 9 patients diagnosed with Charcot arthropathy, 5 had nonunion. Three of five individuals with a BMI ranging from 25-30, and four of six individuals with a BMI of greater than 30 had a nonunion. Infection was a post-operative complication for four of the eighteen patients. Two of the four patients had multiple comorbidities in addition to chronic infections in the joint which were recurrent after surgery. Conclusion: In conclusion, TC arthrodesis provides a viable option for high risk patients with complicated ankle pathology who have not had successful outcomes from previous treatment. It is not without complications considering the comorbidities the patients present with before requiring this procedure. Further studies are necessary in order to validate the trends of outcomes and comorbidities of patients with TC arthrodesis. [Table: see text] </jats:sec

Effect of Pathology on Patient Reported Outcomes of MTP Arthrodesis

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal (MTP) joint arthrodesis of the hallux is a common and reliable procedure performed on patients with various pathologies including hallux rigidus and hallux valgus. While the effect of foot pathology on MTP arthrodesis union rates has been previously explored, there is a lack of literature comparing long term patient reported outcomes between pathology types. The purpose of this present study was to compare patient reported and clinical outcomes following MTP fusion between those with hallux valgus and hallux rigidus. Methods: Patients undergoing primary MTP arthrodesis from 2010-2020 were identified. Additionally, Radiographic follow-up of &gt;12 weeks, no ongoing ipsilateral infection, and complete response to a postoperative patient report outcomes (PROMIS AND Foot Function Index (FFI)) survey were required. After these criteria, 112 patients remained and were grouped by hallux valgus (HV, 53) and hallux rigidus (HR, 59). Medical records were examined for patient characteristics, operative variables, and complications. Patients were grouped by indication and compared. Results: Nonunion rates and complications including wound dehiscence, infection, and reoperation were not different between indications. Patients completed the patient reported outcomes instruments a median of 1.9 years (IQR 2.6) postoperatively. All patient reported outcomes measures were not significantly different between pathology groups with PROMIS physical function ((median, IQR) HR 44.6, 9.9 vs. HV 44.1, 12.2), pain interference (HR 52.8, 9.9 vs. HV 52.4, 12.3), FFI pain scale (HR 33.3, 40.0 vs. HV 28.3, 37.0), FFI disability scale (HR 30.0, 41.0 vs. HV 28.9, 41.0), FFI activity limitation scale (HR 10.0, 27.0 vs. HV 10.0, 23.0), and FFI total (HR 25.8, 50 vs. HV 37.4, 37). Conclusion: Arthrodesis of the first MTP joint provides similar nonunion and complication rates between hallux valgus and rigidus groups. At intermediate follow-up, MTP arthrodesis provides comparable validated patient reported outcomes scores between these two groups. Surgeons should be aware of these results when prognosticating the effect of MTP arthrodesis. </jats:sec