Arthrodesis, Euro quality of life 5 dimension, First metatarsophalangeal joint, Manchester Oxford foot questionnaire, Osteoarthritis, Patient-reported outcome measures, Rheumatoid arthritis, Surgery
Citation Information :
Adukia V, Mishra A, Hughes M, Houchen-Wolloff L, Burgula M, Mangwani J. Do Baseline Scores or Comorbidities Affect Patient-reported Outcome Measures Following First Metatarsophalangeal Joint Arthrodesis?. J Foot Ankle Surg Asia-Pacific 2023; 10 (4):162-165.
Background: Arthrodesis is the gold standard treatment for patients with end-stage arthritis of the first metatarsophalangeal joint (MTPJ). The Manchester Oxford foot questionnaire (MOxFQ) and Euro quality of life (Qol) 5 dimension (EQ-5D) are patient-reported outcome measures (PROMs) commonly used following MTPJ arthrodesis. However, the impact of baseline scores and patient comorbidities on these PROMs is not well studied.
Aim: The aim of this study is to identify the change in PROMs measured by MOxFQ and EQ-5D following the first MTPJ arthrodesis and to determine if the baseline scores and/or presence of comorbidities affected the change observed.
Methods: Data was collected prospectively from patients who had undergone the first MTPJ arthrodesis for end-stage arthritis. The dataset included common comorbidities, baseline PROMs and PROMs following surgery.
Results: A total of 90 patients were identified, of which 52 had complete PROMs data. The mean age was 56.9 ± 17.8 years, and male to female ratio was 1:4. Comorbidities included diabetes (2%), hypertension (21%), rheumatoid arthritis (RA) (43%), and current smokers (10%). The majority of cases were unilateral (94%), and 37% of patients had ipsilateral additional foot procedures carried out concomitantly.
A significant change was seen in all domains of the MOxFQ as well as in the MOxFQ and EQ-5D total (p < 0.01). Baseline scores of both PROMs significantly correlated with the change seen in the scores (r = 0.5 and 0.6, respectively, p < 0.001). The presence of RA was found to significantly reduce the change in the EQ-5D total (p < 0.05).
Conclusion: Following the first MTPJ arthrodesis, statistically significant changes were observed in EQ-5D and MOxFQ total and all the MOxFQ subdomains. Baseline scores in both PROMs correlated well with the change in scores following surgery, suggesting that we may be able to identify a baseline score that could predict outcomes. The presence of RA dampened the change seen in the EQ-5D total, which should form part of preoperative (pre-op) discussions with patients.
Ho B, Baumhauer J. Hallux rigidus. EFORT Open Rev 2017;2(1):13–20. DOI: 10.1302/2058-5241.2.160031.
Bremner JM, Lawrence JS, Miall WE. Degenerative joint disease in a Jamaican rural population. Ann Rheum Dis 1968;27(4):326–332. DOI: 10.1136/ard.27.4.326
Wilder FV, Barrett JP, Farina EJ. The association of radiographic foot osteoarthritis and radiographic osteoarthritis at other sites. Osteoarthritis Cartilage 2005;13(3):211–215. DOI: 10.1016/j.joca.2004.10.021
van Saase JL, van Romunde LK, Cats A, et al. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis 1989;48(4):271–280. DOI: 10.1136/ard.48.4.271
Senga Y, Nishimura A, Ito N, et al. Prevalence of and risk factors for hallux rigidus: a cross-sectional study in Japan. BMC Musculoskelet Disord 2021;22(1):786. DOI: 10.1186/s12891-021-04666-y
Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010;26(3):355–369. DOI: 10.1016/j.cger.2010.03.001
Callahan LF, Shreffler J, Siaton BC, et al. Limited educational attainment and radiographic and symptomatic knee osteoarthritis: a cross-sectional analysis using data from the Johnston County (North Carolina) Osteoarthritis Project. Arthritis Res Ther 2010;12(2):R46. DOI: 10.1186/ar2956
Munteanu SE, Zammit GV, Menz HB. Factors associated with foot pain severity and foot-related disability in individuals with first metatarsophalangeal joint OA. Rheumatology (Oxford) 2012;51(1):176–183. DOI: 10.1093/rheumatology/ker344
Sainio P, Martelin T, Koskinen S, et al. Educational differences in mobility: the contribution of physical workload, obesity, smoking and chronic conditions. J Epidemiol Community Health 2007;61(5):401–408. DOI: 10.1136/jech.2006.048306
Zammit GV, Menz HB, Munteanu SE. Structural factors associated with hallux limitus/rigidus: a systematic review of case control studies. J Orthop Sports Phys Ther 2009;39(10):733–742. DOI: 10.2519/jospt.2009.3003
Beeson P, Phillips C, Corr S, et al. Classification systems for hallux rigidus: a review of the literature. Foot Ankle Int 2008;29(4):407–414. DOI: 10.3113/FAI.2008.0407
Dillard S, Schilero C, Chiang S, et al. Intra- and interobserver reliability of three classification systems for hallux rigidus. J Am Podiatr Med Assoc 2018; DOI: 10.7547/16-126
Shurnas PS. Hallux rigidus: etiology, biomechanics, and nonoperative treatment. Foot Ankle Clin 2009;14(1):1–8. DOI: 10.1016/j.fcl.2008.11.001
Kunnasegaran R, Thevendran G. Hallux rigidus: nonoperative treatment and orthotics. Foot Ankle Clin 2015;20(3):401–412. DOI: 10.1016/j.fcl.2015.04.003
DeCarbo WT, Lupica J, Hyer CF. Modern techniques in hallux rigidus surgery. Clin Podiatr Med Surg 2011;28(2):361–383, ix. DOI: 10.1016/j.cpm.2011.02.001
Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 2003;24(10):731–743. DOI: 10.1177/107110070302401002
Goucher NR, Coughlin MJ. Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study. Foot Ankle Int 2006;27(11):869–876. DOI: 10.1177/107110070602701101
Robinson AH, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg Br 2005;87(8):1038–1045. DOI: 10.1302/0301-620X.87B8.16467
Wu KK. First metatarsophalangeal fusion in the salvage of failed hallux abducto valgus operations. J Foot Ankle Surg 1994;33(4):383–395.
Maher AJ, Kilmartin TE. An analysis of Euroqol EQ-5D and Manchester Oxford Foot Questionnaire scores six months following podiatric surgery. J Foot Ankle Res 2012;5(1):17. DOI: 10.1186/1757-1146-5-17
Patel MR, Jacob KC, Nie JW, et al. The effect of the preoperative severity of neck pain on patient-reported outcome measures and minimum clinically important difference achievement after anterior cervical discectomy and fusion. World Neurosurg 2022;165: e337–e345. DOI: 10.1016/j.wneu.2022.06.044
Abdelhameed MA, Abdelnasser MK, Zaky BR, et al. Preoperative stiffness is the most important predictor of postoperative patient's satisfaction after total knee arthroplasty. Eur J Orthop Surg Traumatol 2023; DOI: 10.1007/s00590-023-03526-w
Fang C, Chen YJ, Fang E, et al. Patient expectations predict outcomes following distal radius fracture: a prospective cohort study using the TEFTOM questionnaire. Injury 2021;52(4):877–882. DOI: 10.1016/j.injury.2020.10.091
Donegan RJ, Blume PA. Functional results and patient satisfaction of first metatarsophalangeal joint arthrodesis using dual crossed screw fixation. J Foot Ankle Surg 2017;56(2):291–297. DOI: 10.1053/j.jfas.2016.10.021
van Doeselaar DJ, Heesterbeek PJ, Louwerens JW, et al. Foot function after fusion of the first metatarsophalangeal joint. Foot Ankle Int 2010;31(8):670–675. DOI: 10.3113/FAI.2010.0670
Cunha RJD, MacMahon A, Jones MT, et al. Return to sports and physical activities after first metatarsophalangeal joint arthrodesis in young patients. Foot Ankle Int. 2019;40(7):745–752. DOI: 10.1177/1071100719842799.
Latif A, Dhinsa BS, Lau B, et al. First metatarsophalangeal fusion using joint specific dorsal plate with interfragmentary screw augmentation: clinical and radiological outcomes. Foot Ankle Surg 2019;25(2): 132–136. DOI: 10.1016/j.fas.2017.09.005
Boonen A, Severens JL. The burden of illness of rheumatoid arthritis. Clin Rheumatol 2011;30(Suppl 1):S3–S8. DOI: 10.1007/s10067-010-1634-9
Jansson KÅ, Granath F. Health-related quality of life (EQ-5D) before and after orthopedic surgery. Acta Orthop 2011;82(1):82–89. DOI: 10.3109/17453674.2010.548026
Benoni AC, Bremander A, Nilsdotter A. Patient-reported outcome after rheumatoid arthritis-related surgery in the lower extremities: a report from the Swedish National Register of Rheuma Surgery (RAKIR). Acta Orthop 2012;83(2):179–184. DOI: 10.3109/17453674.2011.645193