Patients with the most severe flatfoot deformity report the most gains from corrective surgery


01 September 2021

2 minutes to read

Source / Disclosures

Source:

Conti M, et al. Document 232. Presented at: American Academy of Orthopedic Surgeons Annual Meeting; 31 Aug-Sep 3, 2021; San Diego.
Conti MS, et al. Foot Ankle Int. 2020; doi.org/10.1177/1071100720963077.

Disclosures: Ellis reports that he is a member of the board or committee of the American Orthopedic Foot & Ankle Society, that he is on the editorial board or the board of directors of Foot and Ankle Orthopedics, is a Paid Consultant and Paid Presenter or Speaker for Paragon 28, is a Paid Presenter or Speaker for Stryker, and is a Paid Consultant for and receives research support from Wright Medical Technology.


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SAN DIEGO – Patient-reported preoperative outcome measures information system, known as PROMIS, scores are predictive of postoperative improvement at 2 years in patients with adult-acquired flexible foot deformity , showed the data presented.

The purpose of the study, which was conducted at the Hospital for Special Surgery (HSS) and presented at the annual meeting of the American Academy of Orthopedic Surgeons, here, was to determine whether physical function (PF) thresholds and preoperative PROMIS pain interference (PI) could be used to predict which patients would improve clinically at 2 years after reconstruction of adult-acquired flexible deformity of the foot (AAFD), according to the summary of the ‘study.

Scott J. Ellis

“Once the foot starts to collapse, it never collapses, and the concern is that over time the ligaments will continue to stretch, the foot will flatten out and the pain will increase.” Scott J. Ellis, MD, a foot and ankle surgeon at HSS and lead author of the study, said in the press release.

Ellis, Matthew Conti, MD, chief resident of HSS and first author of the article, and colleagues identified 71 adults (75 feet) who underwent surgery for progressive foot deformity between February 2016 and April 2018. The patients all had PROMIS data. available. The mean duration of follow-up was approximately 27 months.

The researchers prospectively collected the PROMIS PF and PI scores preoperatively and at a minimum of 2 years postoperatively. They calculated the minimum differences of clinical significance (DCIM) to determine what represented significant postoperative improvement using the distribution-based method in which the MCID for a particular subscale was determined as half of the deviation. type of score change from the preoperative period to 2 years. postoperative, according to the summary. They determined sensitivity and specificity thresholds of 95% for patients who achieved MCID from receptor operating characteristics (ROC) curves, which had statistically significant areas under the curve (AUC).

At 2 years postoperatively, researchers found significant improvements in PROMIS PF (mean improvement 6.8) and PI (mean improvement 9.3), according to the summary.

In addition, the PROMIS PF ROC analysis demonstrated high precision and a statistically significant AUC, according to the abstract.

In the press release, the researchers said that patients with the lowest preoperative PROMIS PF scores, which indicate the most severe impairment, were the most likely to experience clinically significant improvements 2 years after the procedure. Additionally, patients with a PROMIS-PF score of 45.7 had approximately 14% chance of improvement, while patients with a score below 40.9 had almost 98% chance of clinical gains.

This new information gives surgeons a more objective way to inform patients of their chances of a successful operation, Ellis noted in the press release. “When a patient walks through the door, you can get a feel for their position on that scale, and we know from our study where patients need to land to get clinically meaningful improvements from the surgery,” Ellis said in the press release. “It could be a real-time decision with the patient and something he could follow over time to allow him to see the trajectory of his recovery and where he is headed.”

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