Hey there again!
Welcome back to Ankle Surgery Update – Science guiding treatment your favorite foot and ankle podcast. We are Hans and Sebastian and we are going to present and discuss the following two new articles on foot and ankle surgery:
We hope you enjoy the show!
Hey there again!
Welcome back to Ankle Surgery Update – Science guiding treatment your favorite foot and ankle podcast. We are Hans and Sebastian and we are going to present and discuss the following two new articles on foot and ankle surgery:
We hope you enjoy the show!
Hey again. Welcome back to ankle surgery update, science guiding treatment, your favourite ankle podcast. We're Hanson Sebastian, and we're going to spend the next 15 minutes or so, presenting and discussing two new articles regarding the ankle. The articles chosen our comparison of patients and surgeons expectations in foot and ankle surgery by a magma Hoon at all published and foot and ankle International. The second is effect of age on outcome and revision in total ankle arthroplasty by powerglide are published in the bone and joint journal. Let's start right away with the first one.
Unknown Speaker :Thank you hands. Patient Education is essential aspect and elective foot and ankle surgery. The patient must understand what results to expect in order to make an informed decision whether to undergo surgery or Furthermore, it is obvious and has been shown previously, the patient expectation is strongly associated with a post operative satisfaction. The person educating the patient about the result is the surgeon. Consequently is the first step to verify if the surgeons and patients expectations meet. Therefore, magna Hoon and colleagues aim to assess differences in expectations of foot and ankle surgery between patients and the surgeons. Secondary aims were to assess the effects of major minor surgery, patients demographics and clinical characteristics and individual surgeon on differences in patients and surgeons expectations. The author's performed a prospective study enrolling all consecutive patients scheduled to undergo foot and ankle surgery between February and July 2019 by one of seven fellow trained foot and ankle surgeons. The experience among the surgeons range from one to 28 Yours in practice preoperatively patients and surgeons completed the hospital for special surgery his foot and ankle expectations survey independently. surgeries were divided in major defined as those involving the mid end or hind foot and or after which patients were non weight bearing. Minor surgeries were defined as those after which patients were weight bearing immediately post operatively. various factors were assessed, such as demographic data including sex, age, race, material status, employment status, and pay a type educational level as well as clinical data, including BMI, past medical history and prior surgeries to the Charlson comorbidity index and the use of any assistive device such as a cane, crutches, walker or wheelchair. Differences between patient and surgeon overall expectation scores, number of expectations and number of expectations with company Lead improvement expected were assessed associations between patient demographics and clinical characteristics. Major minor surgery and individual surgeon with differences in expectations were also assessed. 313 patients were eligible for the study 19% were unwilling to participate and 17% could not be which preoperatively the final cohort consists of 202 patients. Overall, 66% of the patients had higher expectations 21 had concordant expectations, and 13% had lower expectations compared to the surgeon. On average, patients had significantly higher expectation scores than the surgeons with 70 points compared to 52. Patients expected complete improvement in a greater number of expectations than surgeons. The items that had the greatest number of patients with higher expectation Then surgeons were improve confidence and foot an anchor, prevent foot and ankle from getting worse and improve pain addressed. Higher BMI and individual surgeons were associated with greater differences between patient surgeon expectations.
Unknown Speaker :Interestingly,
Unknown Speaker :major minor surgery were not associated with differences in the expectations. Taken together. More than two thirds of patients had significantly higher expectations than the surgeons, higher BMA was associated with higher patient than surgeon expectations. The authors concluded
Unknown Speaker :that these results emphasise the importance for foot and ankle surgeons to adequately advocate patients postoperatively
Unknown Speaker :that is really an interesting study, as it is of paramount importance to align the patient's expectations preoperatively in order to have a satisfied patient postoperatively and I agree with the author's that is extremely important to educate the patient about the result that can be expected whatever Found remarkable where the association between individual surgeons with differences in patient and surgeon expectations. The most experienced surgeon with 25 years and experience, for example, tended to have the lowest expectation scores and number of expectations relative to patients. But the second most experienced surgeon with 16 years of experience tended to have a higher expectation score and numbers of expectations relative to patients. This highlights the variability between providers. First, the expectations among the different surgeons different quaintly. Second, the quality to educate the patient regarding the expectations vary greatly. This means what can be expected from a surgery should be based on objective measures, and second, a standardised education of the patient might be reasonable. Consequently, I believe that this study is only the first step. It has been demonstrated there is a large discrepancy Between the surgeon and patients expectations and among the different surgeons, the next step would be to objectify the actual results where the patients or the surgeons expectations met. Therefore, objective and subjective patient outcomes must be assessed and correlated with the expectations. Then, tools must develop and reviewed how to better educate the patient regarding the expectation. Possible tools could be standardised patient education forms, or checklists to ensure all aspects were covered preoperatively examples for this other question if a complete improvement can be expected after the surgery, or can be going back to normal be expected should definitely be discussed with the patient. Another vital tool could be to find a mentor for the patient, meaning to identify a patient who already underwent a specific surgery and who is willing to educate the patients prior to the surgery regarding the results. everyday life, and therefore what to expect from the surgery. This might be elaborate, but could be an option for example, in total ankle arthroplasty, or hind foot a thesis. From my
Unknown Speaker :point of view. This study brings the importance of patients education into the spotlight. It is of paramount importance to objectively educate the patient about the results that can be expected after elective surgery. Only with this knowledge, the patient will be able to make an informed consent whether to be operated on or not. Further, I'm convinced that we need more research and the more standardised way and how that should take place. Thanks, Sebastian.
Unknown Speaker :Let's come to our second paper pick. The paper is entitled effect of age on outcome and revision in total ankle arthroplasty and was published in the bone and joint journal by gallbladder out
Unknown Speaker :over the last 40 years there have been major developments in total ankle arthroplasty but it remains a controversial topic and many aspects are still debated, among others, both indications and contraindications are regularly discussed, especially patient age. Traditionally, it was reserved for older thin patients with low functional demands. Many surgeons still consider patients younger than 50 and older than 70 not suitable due to increased complications and revision rates. However, with advances in surgery and an influence age is among the factors that are continuously reconsidered. The current study aims to assess the effect of age on clinical outcome and revision rates in patients who underwent total ankle arthroplasty for end stage ankle osteoarthritis, a retrospective analysis of consecutive 811 ankles in 789 patients that underwent total ankle arthroplasty between May 2003 and December 2013 was conducted all patient received the Hindi grotto Lanka. The clinical assessment consists of the American orthopaedic foot and ankle society hindfoot score, the eo FA s and pain according to the visual analogue scale the vasse further revision surgeries were recorded. minor revisions were defined as soft tissue procedures, Peri articular, arthrodesis or osteotomies, ankle joint debridement and or English changes. major revisions were considered any exchange of the metallic components or removal of implant followed by ankle or hind foot fusion. The authors defined four different cutoff values for old versus young patients, namely 50 years 5560 and 65 years and compare the same patient sample in these varying cohorts. In older patients primary osteoarthritis was more common compared to the younger group, lateral ligament reconstruction In pure Neil tenant transfer was performed more often than the older patients. Besides that the additional surgical procedures did not differ between the groups. A significant improvement between the preoperative assessment and the last follow up was observed for the eo FA s hindfoot. score from 44 to 76. And device from 6.5 to 2.33 parameters affected the eo FA s improvements patient with preoperatively a low aofm is improved more man improved more compared to women and patients with a post traumatic osteoarthritis improve more than those suffering from other courses. For example, primary osteoarthritis for the vast pain relief increased for each preoperative last point and for each additional year of age. At the time of the total ankle arthroplasty. Consequently, h had a positive effect on pain relief the meaning Until a minor revision was 5.4 years, and the mean risk at that time was 29%. THE MEANTIME for major revision was 6.9 years with a mean risk of 13.5%. At that time, the hazard of revision was not affected by age. The authors concluded that clinical outcome as well as the probability for revision surgery following ankle arthroplasty is considerable between younger and older patients. Therefore, it should no longer be reserved for low demanding elderly patients, but should be recognised as a viable option for active young patients.
Unknown Speaker :The limitation with all these single centre studies is that they do not ensure that patients change the surgeon during the course of the AdvoCare. Consequently, they might have had revision at another institution and are therefore missed. Although the rate of patients with a loss to follow up with 9% is low. This still might negatively affect the outcome. And revision rate. What is needed are national or even better international registry with unique identifiers for each patient, and it should be mandatory for surgeons to participate in these registries. But although the data from national joint registries provides important information and surveillance on the outcomes of total ankle arthroplasty, it must be recognised that these data have limitations as well. There is a debate on how accurately the data reflects the current practice. It lacks proms, and it might only capture part of the true picture. Furthermore, this data is suffering from data confounders and data capture problems especially with under reporting of revision procedures. What example for the confounders in the present study, is that the younger and older group differed regarding the indication in the younger group, posttraumatic osteoarthritis was more common while in the older group, primary osteoarthritis was the most common cause Cause, yet the results following primary arthritis are inferior compared to the post traumatic arthritis. This definitely is a confounder for the results assessed. Furthermore, in this study presented through authors use the A FA s score to objectify the results. Although this score is frequently used, it suffers from various shortcomings, among others, the law reliability and validity. Today, it's well accepted that it is inferior to many other scores available nowadays. Finally, although there is some evidence to support total ankle arthroplasty to conserve ankle motion and offer improved function and decreased pain even in younger patients, it must be recognised that the revision rates are significantly higher than the revision rates for ankle after dieses. Further revision surgery for ankle arthroplasty, or even secondary fusion are very demanding procedures with uncertain results. Furthermore, it is known that the results are stunning Secondary fusion following failed arthroplasty will result in inferior results compared to primary method uses. This must be taken into account when selecting and educating patients for total ankle replacement.
Unknown Speaker :It looks like advances regarding new implants and techniques for total ankle arthroplasty might lead to better mid and long term results. Nevertheless, the procedure leads to high rates of revision surgeries and secondary fusion is a demanding situation with unpredictable results. Therefore, we still believe the patients should be selected carefully. In the end, the patient will have to decide whether he or she wants to take the risk of a total ankle replacement or an ankle fusion. In order to make an informed decision. We will need better data to provide the patient and they must be educated carefully regarding the expectations and the course of treatment. Thank you all for tuning in this time to ankle surgery update science. Adding treatment. It has been a pleasure and we hope you enjoyed this episode as much as we did. As always you can find our podcasts on any regular platform and feel free to follow us at Foose brew lm