Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada.
Department of Orthopedic Surgery, University of Tabuk, Tabuk, Saudi Arabia.
Foot Ankle Int. 2020 Mar;41(3):253-258. doi: 10.1177/1071100719893334. Epub 2019 Dec 9.
Ankle osteoarthritis is a significant cause of pain and disability. Despite the effectiveness of treatments, a subset of patients remains with persistent pain and functional limitations. The purpose of this study was to use preoperative patient-reported outcome measures to predict which ankle osteoarthritis patients would be most likely to experience postoperative improvements in functional outcomes.
A retrospective analysis of prospectively collected data was used to evaluate 427 patients with end-stage ankle arthritis with 5-year follow-up. Demographics, comorbidities, Ankle Osteoarthritis Scale (AOS), Ankle Arthritis Score (AAS), and the physical and mental component scores of the Short Form-36 (SF-36 Physical Components Score [PCS] and Mental Components Score [MCS]) were collected. The minimal clinically important difference (MCID) was then calculated. Receiver operating characteristic (ROC) analysis was used to choose the optimal threshold values of preoperative patient-reported outcome measure and assess the prediction performance.
Patients who scored worst at preoperative baseline made the greatest gains in function and pain relief, and they had a high chance of achieving MCID following surgical treatment. ROC curves demonstrated that preoperative AOS, AAS, and SF-36 PCS and MCS scores were predictive of postoperative improvements in physical and mental function. Patients with preoperative AOS score above 45.7 had an 83% probability of achieving an MCID (AUC = 0.67). Similarly, patients with a preoperative AAS score above 25.7 had a 78% probability of achieving an MCID (AUC = 0.63). Patients with a preoperative SF-36 PCS score below 31 had a 62% probability of achieving an MCID (AUC = 0.64). Patients with a preoperative SF-36 MCS below 52.7 had a 47% probability of achieving an MCID (AUC = 0.89). MCIDs for AOS, AAS, SF3-36 PCS, and SF-36 MCS score changes were 12.4, 10.0, 6.43, and 8.1, respectively.
Preoperative patient-reported outcomes measures could predict postoperative improvement in ankle arthritis patients. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected benefit of surgery.
Level III, prognostic comparative study.
踝关节骨关节炎是疼痛和残疾的一个重要原因。尽管治疗有效，但仍有一部分患者持续存在疼痛和功能受限。本研究旨在使用术前患者报告的结果测量指标来预测哪些踝关节骨关节炎患者最有可能在术后改善功能结局。
使用前瞻性收集的数据进行回顾性分析，评估了 427 例终末期踝关节关节炎患者，随访时间为 5 年。收集了人口统计学、合并症、踝关节骨关节炎量表（AOS）、踝关节关节炎评分（AAS）以及短格式 36 健康调查简表（SF-36 生理成分评分[PCS]和心理成分评分[MCS]）的物理和心理成分评分。然后计算最小临床重要差异（MCID）。使用受试者工作特征（ROC）分析选择术前患者报告的结果测量的最佳阈值值，并评估预测性能。
术前基线得分最差的患者在功能和疼痛缓解方面取得了最大的改善，并且他们在接受手术治疗后有很大的机会达到 MCID。ROC 曲线表明，术前 AOS、AAS 和 SF-36 PCS 和 MCS 评分可预测术后生理和心理功能的改善。术前 AOS 评分高于 45.7 的患者有 83%的可能性达到 MCID（AUC = 0.67）。同样，术前 AAS 评分高于 25.7 的患者有 78%的可能性达到 MCID（AUC = 0.63）。术前 SF-36 PCS 评分低于 31 的患者有 62%的可能性达到 MCID（AUC = 0.64）。术前 SF-36 MCS 评分低于 52.7 的患者有 47%的可能性达到 MCID（AUC = 0.89）。AOS、AAS、SF3-36 PCS 和 SF-36 MCS 评分变化的 MCID 分别为 12.4、10.0、6.43 和 8.1。
术前患者报告的结果测量指标可预测踝关节关节炎患者术后的改善。本研究的结果可用于促进医生和患者之间关于手术预期获益的讨论。
III 级，预后比较研究。
