Trends of Foot and Ankle Publishing in JBJS[A] over a 15 Year Period From 2004-2018

Category: Other Introduction/Purpose: As the field of foot and ankle surgery grows and new innovations continue to be made it is important that the quality of research improves. This will help to lay a strong foundation for current and future surgeons in the field. Leading journals need to set the tone for all orthopedic journals by publishing quality literature. This current study will look at all foot and ankle articles published by JBJS[A] over a 15-year period and analyze authorship, article type, geographic origin of articles, and level of evidence trends. This study will give a representative view of where foot and ankle research is currently and where it can go as we enter the new decade. Methods: A foot and ankle research fellow reviewed all of the articles published in JBJS[A] from January 2004 to December of 2018. Articles that related to foot and ankle topics were then selected to analyzed. Editorials, letters to the editor, announcements, technical notes, retraction notes, events, errata, retracted manuscripts, historical papers and pediatric foot and ankle articles were excluded. After exclusions were applied 321 and information pertaining to each article was analyzed. Additionally, a Google Scholar search was conducted for each article to determine the number of times an article had been cited. For calculations relating to median number of citations for each article we excluded articles that were published less than three years ago (2017 and 2018). For level of evidence a kappa value (0.82) was calculated to measure interobserver reliability between two reviewers. Results: We found the following results to be significant. Clinical therapeutic studies were the predominant study design over 15 years. The amount of literature over ankle arthroplasty has increased more than any other article topic. The amount of level IV and V evidence has decreased and the amount of level II and III evidence has increased. The median number of authors has been increasing. This includes female authorship. There has been in an increase in MD, PhDs as last authors. There is more foot and ankle research being produced by Asian countries. A majority of high level of evidence articles (level I and II) comes from North America and Europe. Level of evidence doesn’t correlate with the amount of times an article is cited. Conclusion: As the field of foot and ankle surgery continues to grow it is important that there is a high quality of research being conducted and published to guide surgical and clinical decisions. Our study shows that research is being produced more globally and the number of individuals involved in the research process is increasing and diversifying. This has led to higher quality research being produced (more level II and III) and a decrease in lower quality research (IV and V). Overall, the standard of research has increased in JBJS[A] which benefits the foot and ankle surgery community. [Table: see text] </jats:sec

Level of Evidence and Authorship Trends in Foot and Ankle Related Trauma Publications

Category: Other Introduction/Purpose: Evidence-based research in the field of foot and ankle related trauma surgery has increased significantly over the past two decades and considerable emphasis is being put on publication quality and level of evidence (LOE). With foot and ankle surgery being a relatively new and growing field of orthopedics, minimal analysis has been performed on the LOE and authorship trends in foot and ankle related trauma publications. The purpose of this study is to evaluate LOE and authorship characteristics in foot and ankle related trauma publications in three different high impact factor journals. Methods: All of the foot and ankle related trauma publications from the years 1997, 2002, 2007, 2012, and 2017 in Foot and Ankle International (FAI), Journal of Trauma (JOT), and The Journal of Bone and Joint Surgery (American and British volumes) (JBJS) were analyzed. LOE of each article was determined by two external reviewers based on the JBJS LOE grading system. Country of origin for the first, last, and corresponding author of each article was evaluated, and fellowship data was obtained from a database for all United States authors. LOE, authorship, and publication trends were compared between both journals and publication year. Results: Over the 15-year period therapeutic studies were the prominent studies in all three journals. JBJS published the highest quality level of evidence and did not publish any level V evidence. The median number of authors was highest in JBJS. JOT publishes a majority of articles from North America (65%) while JBJS publishes more internationally (48% North American). Number of authors increased over time from a median of 3 in 1997 to a median of 5 in 2017. When evaluating the articles with available authorship fellowship data, JBJS and JOT had the highest percentage of articles with a trauma fellowship trained author at 77% and 53%, respectively. FAI had the highest percentage of articles with a foot and ankle fellowship trained author at 34%. Conclusion: From 1997 to 2017, there has been an increase in level 3 evidence foot and ankle related trauma publications and an emphasis on studies being conducted by fellowship trained authors. While the percentage of authors with MDs per publication remained similar over time, this study shows that publications have gradually increased the number of authors over time. There are key differences between the journals including level of evidence. [Table: see text] </jats:sec

Preoperative and Postoperative PROMIS and FFI Scores Based on Region of Foot Pathology and Surgery

Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) has become increasingly utilized in orthopaedic foot and ankle surgery to assess outcomes and better understand patient function, pain, and disability. Similarly, the Foot Function Index (FFI) is used to assess pain, disability, and activity limitation. PROMIS scores have been shown to predict, preoperatively, which patients will benefit most from foot and ankle surgery from a general perspective. It is currently unknown, with regard to chronic foot pathology, which region of the foot has the greatest effect on PROMIS and FFI scores and which region is affected the most by surgical intervention. Methods: PROMIS physical function, pain index, and depression scores along with FFI scoring subsets of pain, disability, and activity limitation were retrospectively reviewed for patients at a tertiary referral center with chronic pathology in either the hindfoot, midfoot, or forefoot that underwent surgery. Scores were obtained preoperatively and at 6 weeks postoperatively, and a preoperative to postoperative difference was calculated. Once the mean of each subcategory was obtained, an analysis of variance (ANOVA) was conducted in order to compare the means and identify statistically significant differences. Significance was set at p &lt; 0.05 and p &lt; 0.10. Results: There was no statistically significant difference between the mean preoperative PROMIS or FFI scores in the forefoot, midfoot, or hindfoot regions. There was also no statistically significant difference between means of PROMIS or FFI categories at 6 weeks postoperatively. However, the mean pre- to postoperative differences between PROMIS physical function scores of the forefoot, midfoot, and hindfoot were statistically significantly different at 9.12, 8.16, and 2.88, respectively (p=0.037). There was no statistically significant difference between the remaining scoring categories. Conclusion: Physical function, pain, depression, disability, and activity limitation are not affected disparately by the location of chronic pathology within the foot. Surgical intervention for problems in the forefoot, midfoot, and hindfoot does not provide differences in outcomes with regard to pain, disability, depression, or activity limitation based on region. Patients who have undergone surgical intervention for forefoot or midfoot pathology may experience greater improvements in physical function postoperatively when compared to patients who have undergone hindfoot surgery. [Table: see text] </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

Incidence and Risk Factors of Preoperative and Postoperative Falls for Patients with Chronic Foot Pathologies: An Institutional Prospective Study

Category: Other; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Individuals with chronic foot pathologies often have an increased fall risk due to decreased power, deformity, or neuropathy. If patients do fall they can suffer injuries leading to emergency room visits, hospital admission, and surgery. Additionally, falls can increase the severity of their existing condition. This leads to an increase cost burden on the healthcare field and can ultimately decrease the quality of life for the patient. It is important to identify which foot pathologies are associated with the highest fall risk preoperatively and postoperatively. This study analyzes preoperative and postoperative fall data for patients with a variety of common forefoot, midfoot, and hindfoot pathologies. Methods: Over the course of 2019 70 patients had preoperative and 2-week and 6-week postoperative fall data collected in clinic prior to and after surgery. These patients were subdivided into three cohorts based on the location of foot pathology. This included 25 patients for forefoot, 20 patients for midfoot and 20 patients for hindfoot. We had patients complete several surveys that pertained to previous fall history, fall risks, fall history after surgery, current medical status, and use of an assistant device. The John’s Hopkins Fall Risk Assessment tool and the survey pertaining to fall risk from the national council on aging were validated surveys that were completed. Results: Patients that suffered from a hindfoot pathology had the highest risk of suffering a fall preoperatively. Of the 25 patients in the hindfoot cohort 36% experienced at least one fall in the 12 months prior to surgery. Patients with forefoot and hindfoot pathologies experienced the most falls prior to surgery (0.64 and 0.60 respectively). Postoperatively patients with midfoot pathologies had the highest frequency of falls with 35% experiencing at least one fall within the 2-week period after surgery. The midfoot cohort also experience the most falls postoperatively averaging 0.50 falls. Preoperatively all patients completed a John’s Hopkins fall risk assessment and the scores for forefoot midfoot and hindfoot were 6.32, 4.70, 6.96 respectively. With a score of over 6 indicating moderate fall risk. Conclusion: This information can help to identify which patients undergoing surgery for chronic foot pathologies are at the highest risk for preoperative and postoperative falls. Our study suggests that individuals with hindfoot pathologies are at greatest risk for preoperative falls and patients with midfoot pathologies have the greatest risk for postoperative falls. This study can help to guide patient management and decrease fall risk by understanding which patients are most susceptible. We are currently undertaking a prospective study looking at how preoperative mobility device training can reduce postoperative fall risk. [Table: see text] </jats:sec