Investigating how the degree of radiological correction corresponds to patient reported outcomes in scarf osteotomy

K. Ahmad, M. Ballal, N. Lal, A. Pillai

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.