Aims

Patients with diabetes are at increased risk of wound complications after open reduction and internal fixation of unstable ankle fractures. A fibular nail avoids large surgical incisions and allows anatomical reduction of the mortise.

Purpose: To describe the pre- and one-year post-operative preference-based, health related quality of life (health state values) among a cohort of subjects with end-stage ankle arthritis treated with total ankle arthroplasty or ankle arthrodesis. This short-term study is not intended to compare the efficacy of arthoplasty and arthrodesis.

Method: The Short-Form 36 (SF-36) was prospectively completed by subjects enrolled in the Canadian Orthopaedic Foot and Ankle Society Multicentered Ankle Arthritis Outcome Study between 2003 and 2005. Preference-based quality of life was assessed pre-operatively and at one-year post-procedure using health state values (HSVs) derived from the SF-36 transformation described by Brazier (SF-6D). The SF-6D scores are anchored at 1.0 (full health) and at 0 (death). Basic patient demographic and treatment information was also collected. The decision to perform arthroplasty or arthrodesis was made by the attending surgeon.

Results: Two hundred four of the 214 eligible subjects had complete preoperative SF-36 data to allow transformation to SF-6D values. One-year follow-up was available for 114 of the participants. The mean age at surgery of the included subjects was 58.9 +/− 13.3 years. Of the patients with one-year follow-up, 56% were male and 59% had received total ankle arthroplasty. These demographics did not differ from the original preoperative cohort. The mean SF-6D score among all subjects with end-stage ankle arthrosis was 0.66 (95% CI 0.65 – 0.68). At one-year, the mean HSVs of the total ankle arthroplasty and ankle arthrodesis groups were 0.73 (95% CI 0.71 – 0.76) and 0.73 (95% CI 0.70 – 0.75), respectively. The reported pre-operative scores describe health states below normative data for the US population (0.76 +/− 0.01 for females, ages 55–64).

Conclusion: These are the first available HSVs for a cohort of patients with end-stage ankle arthritis treated with total ankle arthroplasty or ankle arthrodesis. These data demonstrate an improvement in preference-based quality of life following ankle arthroplasty or arthrodesis. At one-year follow-up, patient reported HSVs approach age-matched US norms.

Summary: The SF-36, FFI, AOS and the AOFAS AHS were recorded pre and post-operatively in patients with end-stage ankle arthritis. Comparison of responsiveness shows the AOFAS score to be completely unresponsive.

Introduction: Outcome studies should include both general health and disease specific measures. The Short Form 36 (SF36) is validated and widely used in musculoskeletal disease. A number of disease specific scores are available for the foot and ankle but, at present there is no widely agreed and validated score used specifically in end-stage ankle arthritis (EAA).

Methods: 555 sets of pre and post-operative data on 239 EAA patients undergoing definitive treatment have been collected. The SF36 and three widely used Foot and Ankle scores (Foot Function Index (FFI), AOFAS Ankle Hindfoot Score (AHS) and Ankle Osteoarthritis Scale (AOS)) were recorded. We assessed the responsiveness (Standardized Response Mean (SRM) and Effect Size (ES)) and correlation (Spearman Rank Correlation) of each of the above scores.

Results: The SF36, FFI and AOS responded to change and correlated in sub-scale and total scores. The AHS did not respond to change in pain or total scores and did not correlate with any other score.

Using the three responsive scores there was a significant improvement in outcome with operative intervention (p< 0.0001) with each score. Using the SRM and the ES, the AOS showed the highest level of responsiveness. It also showed an increased response rate suggesting that patients find it more useable.

Conclusion: In future studies we would recommend the use of the SF36 and the AOS for assessment of patients with EAA. We would also discourage use of the AOFAS Ankle Hindfoot Score which we have demonstrated to be unresponsive to change.