Association of Visual Appearance on Outcomes After Hallux Valgus Surgery

2021 ◽  
pp. 107110072110199
Author(s):  
Hakan Bahar ◽  
Kadir Ilker Yildiz

Background: In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery. Methods: Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles. Results: There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022). Conclusion: Visualizing improvement in the cosmetic appearance of the foot appears associated with patients’ perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded. Level of Evidence: Level III, case-control study.

2018 ◽  
Vol 39 (7) ◽  
pp. 795-800 ◽  
Author(s):  
Rachel Shakked ◽  
Elizabeth McDonald ◽  
Ryan Sutton ◽  
Mary-Katherine Lynch ◽  
Kristen Nicholson ◽  
...  

Background: The relationship between depressive symptoms and patient outcomes after hallux valgus surgery has not been well-studied. We hypothesized that patients with depressive symptoms would have greater subjective dysfunction preoperatively and less functional improvement and satisfaction after surgery when compared with patients without depressive symptoms. Methods: A total of 239 adult patients who had surgical hallux valgus correction over a 2-year period were retrospectively enrolled. A telephone survey was administered prospectively at least 11 months postoperatively inquiring about overall satisfaction level with surgery and satisfaction with postoperative pain level. A scale of 0 to 6 was used, with 0 indicating complete dissatisfaction and 6 indicating complete satisfaction. Patients were divided into 2 groups based on depressive symptoms; a Short Form–12 mental component score (SF-12 MCS) of less than 45.6 points was considered indicative of active depressive symptoms based on literature correlating SF-12 scores with Patient Health Questionnaire–9 for depression. Given the great variability of depressive symptoms in patients with or without self-reported depression and medicated or unmedicated status, we elected to use the MCS classification of depressive symptoms for our analysis. Data from 239 patients were available for analysis, with an average age of 51.6 years and 207 women (87%). Two hundred eighteen patients (91%) completed preoperative functional scores, 160 patients (67%) completed the satisfaction survey at an average of 23 months postoperatively (range 11 to 43 months), and 154 patients (64%) completed postoperative functional scores an average of 21 months postoperatively (range, 11-44 months). Results Thirty-six of 239 patients (15%) with baseline functional scores exhibited depressive symptoms. There was no significant difference in baseline functional scores and pain levels between groups with the exception of the SF-12 MCS ( P < .001). Most outcomes improved significantly over time, including the SF-12 physical component score ( P = .013), Foot and Ankle Ability Measure (FAAM; P = .013), and FAAM Activities of Daily Living ( P = .046). The patients with depressive symptoms generally had lower scores at baseline and final follow-up in all functional scores, with the exception of visual analog scale (VAS). VAS pain scores started higher in the group of patients with depressive symptoms and ended lower. Satisfaction with postoperative pain was lower in the group with depressive symptoms when compared with patients without depressive symptoms (3.6 vs 4.5, P = .042). There was no significant difference in satisfaction after surgery between groups ( P = .251). Conclusion: Patients with depressive symptoms had greater pain at baseline and less pain postoperatively when compared with patients without depressive symptoms; however, satisfaction levels with postoperative pain were lower in these patients. Furthermore, most functional scores were lower in patients with depressive symptoms, with the exception of the MCS. Reported history of depression was not associated with any significant difference in functional outcome scores or satisfaction. Further study is warranted to determine why patients with depressive symptoms fare worse after surgical hallux valgus correction by most subjective measures. Level of Evidence: Level III, comparative study.


2005 ◽  
Vol 3 (2) ◽  
pp. 129-141 ◽  
Author(s):  
Claudius Thomé ◽  
Dimitris Zevgaridis ◽  
Olaf Leheta ◽  
Hansjörg Bäzner ◽  
Christiane Pöckler-Schöniger ◽  
...  

ObjectRecently, limited decompression procedures have been proposed in the treatment of lumbar stenosis. The authors undertook a prospective study to compare the safety and outcome of unilateral and bilateral laminotomy with laminectomy.MethodsOne hundred twenty consecutive patients with 207 levels of lumbar stenosis without herniated discs or instability were randomized to three treatment groups (bilateral laminotomy [Group 1], unilateral laminotomy [Group 2], and laminectomy [Group 3]). Perioperative parameters and complications were documented. Symptoms and scores, such as visual analog scale (VAS), Roland—Morris Scale, Short Form—36 (SF-36), and patient satisfaction were assessed preoperatively and at 3, 6, and 12 months after surgery.Adequate decompression was achieved in all patients. The overall complication rate was lowest in patients who had undergone bilateral laminotomy (Group 1). The minimum follow up of 12 months was obtained in 94% of patients. Residual pain was lowest in Group 1 (VAS score 2.3 ± 2.4 and 4 ± 1 in Group 3; p < 0.05 and 3.6 ± 2.7 in Group 2; p < 0.05). The Roland—Morris Scale score improved from 17 ± 4.3 before surgery to 8.1 ± 7, 8.5 ± 7.3, and 10.9 ± 7.5 (Groups 1–3, respectively; p < 0.001 compared with preoperative) corresponding to a dramatic increase in walking distance. Examination of SF-36 scores demonstrated marked improvement, most pronounced in Group 1. The number of repeated operations did not differ among groups. Patient satisfaction was significantly superior in Group 1, with 3, 27, and 26% of patients unsatisfied (in Groups 1, 2, and 3, respectively; p < 0.01).ConclusionsBilateral and unilateral laminotomy allowed adequate and safe decompression of lumbar stenosis, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life. Outcome after unilateral laminotomy was comparable with that after laminectomy. In most outcome parameters, bilateral laminotomy was associated with a significant benefit and thus constitutes a promising treatment alternative.


Author(s):  
Fernando Cancella Da Silva ◽  
Wilel de Almeida Benevides ◽  
Thiago Alexandre Alves da Silva ◽  
Luciana Silveira Monteiro ◽  
Pedro Costa Benevides

Objective: To evaluate the quality of life of patients undergoing ankle arthrodesis through functional scores such as the American Orthopedic Foot & Ankle Society (AOFAS) scale adapted for the Portuguese language and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Methods: A descriptive cross-sectional study was carried out between January 2005 and December 2016, with 26 patients undergoing anklearthrodesis. Two quality of life assessment questionnaires were applied: the AOFAS in the pre- and postoperative period and the SF-36 in the postoperative period. Descriptive and analytical statistical analyses were performed using SPSS, version 23. Results: The main findings are related to the correlations of functional capacity (p=0.002; R²=0.42), limitation due to physical aspects (p=0.05; R²=0.19) and pain (p=0.006; R²=0.35) with age as the predictor and the correlation between preoperative AOFAS scores (p=0.03; R²=0.27) and the aetiology of arthrodesis as the predictor. Conclusion: Ankle arthrodesis is a procedure capable of improving the quality of life of the patient as a whole, including the physical, social, emotional and mental health aspects, rather than pain alone, which has been the main objective of the procedure until the present moment. Level of Evidence II; Prognostic Studies.


2015 ◽  
Vol 14 (4) ◽  
pp. 290-294
Author(s):  
Rodrigo Góes Medéa de Mendonça ◽  
Carlos Alberto Assunção Filho ◽  
Nelson Astur ◽  
Alberto Ofenhejm Gotfryd ◽  
Ricardo Shigueaki Galhego Umeta ◽  
...  

Objective : To evaluate and compare radiographic and clinical evaluation of patients undergoing interbody fusion versus posterolateral fusion of the lumbar spine. Methods : Retrospective study of patients diagnosed with lumbar spondylosis that were surgically treated in the period from 2012 to 2014. The results were observed by clinical evaluation by the Visual Analogue Scale (VAS) for low back and leg pain. We evaluated functional results and quality of life through the application of the Oswestry Disability Index (ODI) and the Short Form-36 (SF-36) questionnaires, respectively. The pre and postoperative condition were compared in Group 1 (interbody fusion) and Group 2 (posterolateral fusion), in addition to evaluation of fusion by means of post-operative radiograph. Results : A total of 30 patients of 36 were eligible, 12 in Group 1 and 18 in Group 2. The mean follow-up was 10.1 months. Statistical analysis showed similar scores for back and leg pain VAS, SF-36 function scores and Oswestry between groups with interbody and posterolateral fusion, and compared within these groups regarding the pre- and postoperative condition, and found no statistical significance. The successful fusion was similar in both groups, with 11 of 12 patients in Group 1 showing bone fusion and 17 of 18 in Group 2 showing arthrodesis. Conclusion : No clinical or radiographic differences between patients who underwent posterolateral or interbody fusion were observed. Both methods showed improvement in functional outcome and pain reduction.


2008 ◽  
Vol 8 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Richard D. Guyer ◽  
Fred H. Geisler ◽  
Scott L. Blumenthal ◽  
Paul C. McAfee ◽  
Bradford B. Mullin

Object Lumbar arthroplasty is approved in the US for the treatment of degenerative disc disease at 1 level in skeletally mature patients. However, a bias toward older patients (> 45 years of age) who are otherwise indicated for the procedure may exist. In this study, the clinical outcomes of patients from the Charité Investigational Device Exemption (IDE) study were analyzed on the basis of patient age. Methods There were 276 patients enrolled in the IDE study of the Charité Artificial Disc who underwent 1-level arthroplasty at either L4–5 or L5–S1, including 71 nonrandomized and 205 randomized individuals. Patient data were analyzed based on age (18–45 years [217 patients, Group 1] compared with 46–60 years [59 patients, Group 2]). Statistical analyses were performed based on 2-year postoperative improvements in Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36), and visual analog scale (VAS) scores (clinical outcome), as well as range of motion (radiographic outcome), and adverse events. Results There was no significant difference between the groups with respect to level implanted, operative time, blood loss, changes in ODI and VAS scores or any of the 8 component scores of the SF-36, compared with baseline, at all time points throughout the 24-month follow-up period (p > 0.10). Patient satisfaction was equivalent at 24 months, with 87% satisfaction in Group 1 and 85% satisfaction in Group 2 (no statistical difference). In addition, no significant differences were identified with respect to adverse events including approach related, neurological, technique related, or reoperation. Conclusions Although patients > 45 years of age may have comorbidities or contraindications for arthroplasty for a number of reasons, particularly osteopenia, this analysis demonstrates that patients who are indicated for 1-level arthroplasty experience similar clinical outcome, satisfaction, or adverse events compared with their younger counterparts.


2020 ◽  
Vol 41 (9) ◽  
pp. 1079-1091 ◽  
Author(s):  
Henryk Liszka ◽  
Artur Gądek

Background: The objective of the study was evaluation of the clinical and radiologic outcomes and complications following the minimally invasive chevron procedure employing the Akin osteotomy with percutaneous transosseous suture as compared to screw fixation. Methods: Between 2018 and 2019, the authors performed 103 minimally invasive chevron (MIC) with Akin osteotomies. In 54 patients, the Akin osteotomy was performed with screw stabilization (group A), and in 49 with percutaneous transosseous suture (group B). Preoperatively and 1 year later, the authors employed anteroposterior and lateral weightbearing radiographs of the feet to evaluate interphalangeal angle (IPA), distal phalangeal articular angle (DPAA), proximal phalangeal articular angle (PPAA), intermetatarsal angle (IMA), hallux valgus angle (HVA), and functional result using the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. Furthermore, all additional procedures and complications were recorded. Results: Both groups demonstrated a statistically significant decrease of the value of HVA (group A: from 34.1° to 14.0°, group B: from 33.6° to 13.0°), DPAA (group A: from 12.1° to 4.0°, group B: from 11.5° to 3.4°), PPAA (group A: from 4.6° to 1.7°, group B: from 4.3° to 1.5°), IMA (group A: from 15.1° to 8.0°, group B: from 14.7° to 7.5°) and IPA (group A: from 14.1° to 6.3°, group B: from 12.9° to 5.1°). Functional improvement as measured using the AOFAS scale was achieved in both groups (group A: from 42 to 90 points, group B: from 40 to 89 points). No cases of bone nonunion or delayed union and permanent damage to the medial dorsal cutaneous nerve were seen. Two group B patients underwent conversion of the fixation of the Akin osteotomy to screws, 3 patients had their MICA screws and 1 Akin screw removed in the outpatient setting. Conclusion: The minimally invasive chevron osteotomy with transosseous suture stabilization of the Akin osteotomy was a safe method with good functional results that were comparable to the outcomes achieved when using screw fixation. Level of Evidence: Level III, retrospective comparative study.


Author(s):  
Pablo E. Gelber ◽  
Raúl Torres-Claramunt ◽  
Francesco Poggioli ◽  
Daniel Pérez-Prieto ◽  
Joan C. Monllau

AbstractMeniscal extrusion (ME) has been identified as a risk factor in the development of knee osteoarthritis. The relevance of this finding when a meniscal scaffold is used has not been extensively studied. The objective of this study was to determine whether preoperative meniscal remnant extrusion (MRE) was correlated with postoperative scaffold extrusion (SE) or with functional outcomes at the 2-year follow-up. Retrospective study included all polyurethane scaffolds implanted with a minimum 2-year follow-up. A magnetic resonance imaging (MRI) was performed preoperatively and postoperatively at 2 years. Extrusion was measured in millimeters in a coronal view. Patients were assigned to either group 1 or 2 depending on the preoperative MRE being either <3 mm (minor extrusion) or 3 mm (major extrusion). Functional outcomes were analyzed by means of the Western Ontario Meniscal Evaluation Tool (WOMET), International Knee Documentation Committee, Kujala and Tegner scores, as well as visual analog scale. Satisfaction was also documented. Sixty-two out of 98 patients were available to undergo an MRI at final follow-up. The mean age was 41.3 years (range, 17–58) and the mean follow-up was 45 months (range, 25–69). The mean preoperative MRE was 2.8 mm (standard deviation [SD] 1.2) and the mean postoperative SE was 3.8 mm (SD 1.8) (p < 0.01). All functional scores improved during the study period. When the correlation (Spearman's rho) between the difference in extrusion between the pre 26 and postoperative periods and their correlation with the different scores was assessed, correlation was only observed in the WOMET (rho 0.61, p = 0.02). The preoperative MRE in Group 1 was 1.85 mm (SD 0.83) and 3.7 mm (SD 2.2) in Group 2 (p < 0.01). At final follow-up, SE was 3.86 mm (SD 0.7) in Group 1, whereas it was 3.98 mm (SD 1) in Group 2 (p = 0.81). No differences were observed in the scores used for these two groups. The SE observed at the 2-year follow-up after the implantation of a polyurethane scaffold did not depend on preoperative MRE (major or minor extrusion). The WOMET score, which was the only meniscal-specific functional scored used, showed some inferior results in the most extruded meniscal scaffolds. This is a retrospective case series. Level of evidence is 4.


2021 ◽  
pp. 036354652199080
Author(s):  
Sean M. Kennedy ◽  
Joseph P. Hannon ◽  
John E. Conway ◽  
Kalyssa Creed ◽  
J. Craig Garrison

Background: Increased humeral retrotorsion (HRT) has been found to be a risk factor for ulnar collateral ligament (UCL) tears in baseball players. Recent work has demonstrated the age of 11 years as a potential watershed age for HRT development. Hypothesis: In a group of baseball pitchers with UCL injuries, athletes who started pitching before the age of 10 years will demonstrate significantly more dominant limb humeral retrotorsion (DHRT) when compared with a group of baseball pitchers who reported starting pitching at 10 years or older. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 baseball pitchers with a diagnosed UCL injury were divided into 2 groups based upon the age at which participants began pitching: 33 players reporting a starting pitching age of 10 years or older (group 1) were compared with 51 baseball pitchers reporting a starting pitching age under 10 years (group 2). Participants’ DHRT and nondominant limb humeral retrotorsion (NDHRT) were measured using diagnostic ultrasound. Independent t tests were run to compare mean group differences of all patient data, starting pitching age, age at time of injury, DHRT, NDHRT, and humeral retrotorsion difference (HRTdiff). Results: There were no significant differences between groups with regard to age at time of injury, height, weight, or playing years’ experience. There was a statistically significant difference in the participant-reported starting pitching age. Significant differences between groups were noted for DHRT (group 1: 20.0°± 9.4°, group 2: 14.5°± 10.3°, P = .015) and for NDHRT (group 1: 38.6°± 8.8°, group 2: 32.9°± 9.5°, P = .007). No significant differences between groups were found for HRTdiff ( P = .940). Conclusion: Baseball pitchers with a UCL injury who reported a starting pitching age younger than 10 years demonstrated significantly greater DHRT and NDHRT when compared with UCL-injured baseball pitchers who reported a starting pitching age at 10 years or later. The results of this study demonstrate that a younger starting pitching age results in increased HRT in players with UCL injuries.


2018 ◽  
Vol 40 (3) ◽  
pp. 287-296 ◽  
Author(s):  
Gerhard Kaufmann ◽  
Stefanie Sinz ◽  
Johannes M. Giesinger ◽  
Matthias Braito ◽  
Rainer Biedermann ◽  
...  

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.


2016 ◽  
Vol 15 (1) ◽  
pp. 33-35
Author(s):  
Jose Alfredo Corredor ◽  
Fernando Flores de Araújo ◽  
Rodrigo Góes de Mendonça ◽  
Noel Oizerovici Foni ◽  
Nelson Astur ◽  
...  

ABSTRACT Objective: To evaluate clinical and functional results of patients with lumbar degenerative spondylolisthesis treated with operatively or nonoperatively. Methods: Patients with degenerative spondylolisthesis treated either nonoperatively or operatively from 2004 to 2014 were selected from databases and a cross-sectional evaluation was performed. Outcome measures included back and leg visual analogue scales (VAS), Fischgrund criteria, Short Form-36 (SF-36) function score, and the modified Oswestry Disability Index (ODI). Results: 43 patients were evaluated: 20 with nonoperative treatment and 23 with operative treatment. Baseline characteristics were similar without significant differences between groups. Mean follow-up time was 43 months (range 10 - 72) for the nonoperative group and 36 months (range 6-80) for the operative group. Significant statistical difference in favor of operative group were found in back VAS (mean 4 versus 8, p = 0.000), leg VAS (mean 3 versus 6, p = 0.0015), SF-36 function score (mean 77 versus 35, p = 0.000), and ODI (mean 17 versus 46, p = 0.000). On the basis of the Fischgrund criteria, only 10 % of patients reported excellent or good health post nonoperative treatment versus 83% for those treated operatively (p = 0.000). Conclusion: In this cross-sectional study, we observed that symptomatic patients with degenerative spondylolisthesis who underwent operative treatment have superior clinical and functional scores compared to those that underwent nonoperative treatment.


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