Warwick Medical School, University of Warwick, Coventry, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
Bone Joint J. 2023 Aug 1;105-B(8):895-904. doi: 10.1302/0301-620X.105B8.BJJ-2022-1242.R1.
The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures.
Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics.
Data from 238 patients were analyzed. There were significant improvements in MOXFQ and EQ-5D-5L among people who underwent TAA at six- and 12-month assessments compared with preoperative scores (p < 0.001). Most improvement occurred between preoperative and six months, with little further improvement at 12 months. A greater improvement in MOXFQ outcome postoperatively was associated with older age and more advanced radiological signs of ankle osteoarthritis at baseline.
TAA significantly benefits patients with end-stage ankle disease. The lack of substantial further overall change between six and 12 months suggests that capturing PROMs at six months is sufficient to assess the success of the procedure. Older patients and those with advanced radiological disease had the greater gains. These outcome predictors can be used to counsel younger patients and those with earlier ankle disease on the expectations of TAA.
本研究的目的是从接受全踝关节置换术（TAA）的代表性多中心患者队列中获得 12 个月的结果，描述 12 个月时患者报告的结果测量指标（PROM）的模式，并确定这些结果测量指标的预测因素。
2016 年 2 月至 2017 年 10 月期间，19 家 NHS 医院列出的初次 TAA 患者符合条件。在术前、术后 6 个月和 12 个月采集 PROM 数据，包括：曼彻斯特-牛津足部和踝关节问卷（MOXFQ（足部和踝关节））和欧洲五维健康量表（EQ-5D-5L）。术前和术后的放射学数据包括 Kellgren-Lawrence 评分和植入物位置测量。通过与国家联合登记处记录链接来补充这些数据，以确定：指数手术时的美国麻醉医师协会（ASA）分级；手术指征，指数踝关节既往骨折；胫骨后足对线；TAA 时的额外手术；以及植入物类型。多变量回归模型评估了结果，并评估了 MOXFQ 和 EQ-5D-5L 结果与患者特征之间的关系。
对 238 名患者的数据进行了分析。与术前评分相比，接受 TAA 的患者在术后 6 个月和 12 个月时的 MOXFQ 和 EQ-5D-5L 均有显著改善（p < 0.001）。大多数改善发生在术前和术后 6 个月之间，12 个月时改善不大。术后 MOXFQ 结果的改善与年龄较大和基线时踝关节骨关节炎的放射学征象更严重有关。
TAA 显著有益于终末期踝关节疾病患者。术后 6 个月至 12 个月之间总体变化不大，提示在评估手术成功时，6 个月时采集 PROM 就足够了。年龄较大的患者和放射学疾病较重的患者获益更大。这些结果预测因素可用于向年轻患者和踝关节疾病早期患者提供 TAA 的预期。
