Investigating how the degree of radiological correction corresponds to patient reported outcomes in scarf osteotomy
K. Ahmad, M. Ballal, N. Lal, A. Pillai
1University Hospital of South Manchester, Trauma and Orthopaedics, Manchester, United Kingdom
Background: Patient-reported outcome measures (PROMs) are important in modern healthcare systems. Previous studies on PROMs in hallux-valgus (HV) surgery show links with age/gender. We investigated the relationship between pre-/post-op radiological appearance and PROMs in hallux-valgus surgery.
Patients and methods: Prospective study of 40 patients with hallux-valgus undergoing scarf-osteotomy. Data collection performed using EQ-5D VAS, EQ-5D Health-Index, and the Manchester-Oxford Foot Questionnaire (MOxFQ). All radiological measurements (HVA- hallux-valgus angle and IMA- Intermetatarsal angle) calculated by two independent blinded foot and ankle surgeons on PACS. Comparative analysis done between degree of radiological correction and pre-/post-op PROMs. Statistical tests carried out using IBM-SPSS Statistics (V19).
Results: Patient demographics- 40 patients included in the study with female predominance, equal side distribution and no bilateral procedures. Average age at time of surgery- 60.7 years (Range 29-88). Mean pre-op MOxFQ=50.6 (10.0-98.7), mean post-op MOxFQ=23.6 (0-91.3) and mean improvement in MOxFQ=27.1 (-81.3-73.3). All MOxFQ scores showed statistically significant improvement post-operatively. Greatest improvement in over 65s and female subgroups. p< 0.05. For HVA- average pre-op angle=34.6° (13.2°-57.0), average post-op angle=14.9° (2.0-39.1). Mean HVA correction angle= 20.0 (3.2- 47.5). There was statistically significant correlation between pre-op/post-op HVA measurements and pre-op/post-op PROMS values respectively (p< 0.05). There was direct correlation between HVA correction and improvement in PROMS. For IMT, average Pre-op angle=17.3° (10.4-27.6), average Post-op angle=12.1° (6.0-21.1). Mean IMA Correction=5.29 (0.2-15.8). There was statistically significant correlation between pre-op/post-op IMA measurements and pre-op/post-op PROMS values respectively (p< 0.05). There was direct correlation between IMA correction and improvement in PROMS.
Conclusion: Hallux-valgus surgery is an effective procedure with high PROMS. Maximal improvement is seen in over 65s and female subgroups. There is a positive correlation between PROMS and degree of deformity. As HVA/IMA increase, PROMs decrease. As HVA and IMA correction increases, PROMs improves. Better surgical correction leads to better PROMS.
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