1. Patient expectation and satisfaction in end stage ankle arthritis: Comparison of ankle replacement and fusion
Younger A, Glazebrook M, Penner M, Daniels T, Wing K, Dryden P, Wong H.
University of British Columbia, Victoria Hospital, St. Paul’s Hospital, University of Toronto, St. Michael’s Hospital, Dalhousie University, Queen Elizabeth Health Sciences Center
Study group
Change in SF - 36 PCS scale
Background
Outcome scores usually measure pain and function, such as the Ankle Osteoarthritis Scale (AOS). Preoperative expectation requires patient education to instruct patients on the likely outcome.
Expectation has been measured in shoulder surgery, spine surgery, hip and knee joint replacement and ACL reconstruction. We are not aware of a similar study in ankle arthritis.
Satisfaction with surgery has been quantified for hip and knee joint replacement.
Preoperative expectation by year
Demographics
Purpose
The purpose of this study was to compare the results of ankle fusion and replacement using the AAOS MODEMS score for expectation and satisfaction.
Methods
656 joints in 623 patients were compared for 205 fusions (AF) and 451 arthroplasties (TAA) followed an average of 61 months. The expectation score asked patients what they expected their outcome to be based in five areas: Relief of symptoms, household activities, sleep, employment, recreation and disability and scored 0 to A high preoperative score indicates high expectations and a low score postoperatively indicates expectations were met. MODEMS Satisfaction is a five-point scale asking patients how satisfied they would be if they had to live the rest of their life with their current symptoms.
Results
Conclusion
MODEMS expectation score
Screw fixation used in the arthroscopic technique
Patients with TAA had significantly higher expectations prior to surgery and but had similar expectations met score to AF. TAA patients were more likely to improve in satisfaction with symptoms after surgery. Otherwise all other preoperative and postoperative scores were the same for TAA and AF. Expectation before surgery correlates poorly with AOS score indicating that expectation is poorly related to pain and function. Expectations met and satisfaction had a better relationship with AOS scores at follow up indicating that follow up scores more relate to pain and function.
In the future preoperative education may need to be scored to determine how it affects preoperative expectation.
MODEMS satisfaction score
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