Introduction: Although decompressive surgery of spinal stenosis is a common procedure in spine surgery, there are no studies assessing patients’ perceived health related quality of life (HRQOL) by EQ-5D. An objective was to describe status overall and by analyzing pre- and one year postoperative health related quality of life (HRQOL) by the EQ-5D instrument in patients operated on for lumbar spinal stenosis. This cohort was compared to a Swedish population EQ-5D survey. Methods: Data were obtained from the National Swed-ish Registry for lumbar spine operations 2001–2002. On 230 patients (mean age 66 years, 53% females) operated on for lumbar spinal stenosis the primary outcome measures were pre- and postoperative EQ-5D data. In addition, patient and disease characteristics (pain and walking ability) were reported. Analysis of variance (ANOVA) was performed and the relative differences pre-and postoperatively compared to a Swedish population survey were calculated. Results: The majority of patients experienced an improved and their EQ-5D score increased from 0.36 to 0.64 one year after operation. However, they did not reach the level reported by an age- and gender matched population sample (mean difference 0.18). Woman had lower pre- and postoperatively EQ-5D scores than men. Preoperative severe pain was a significant predictor for a lower postoperative EQ-5D score. Four out of ten reported considerable improvement while a similar portion of patients (41%) with high preoperative scores were slightly improved. A third group (14%) were unchanged with low EQ-5D scores, and a few (4%) perceived a decline in their HRQOL. The mean VAS rating of leg- and back pain improved one year after operation by 28 and 29 %, respectively. The proportion of patients able to walk longer than 500 m increased from 25 % preoperatively to 65 % postoperatively. Conclusions: Our national Swedish representatively cohort of disc herniation patients has a remarkable low EQ-5D scores preoperatively. However their HRQOL improved considerably in 80 % of the patients one year after surgery. The health related quality of life improves after surgery for lumbar spinal stenosis, approaching the population reference level. It is of most importance to further investigate the risk factors behind the less favourable outcomes in health related quality of live (EQ-5D score) in women

Purpose. To evaluate comorbidity and health-related quality of life in patients with idiopathic scoliosis. Patients and methods. 496 patients treated with Boston brace for idiopathic scoliosis were invited for long-term follow-up. 361 women and 29 men responded. Mean age was 39.2 (4.6) years; mean follow-up time 23.4 (4.3) years. 28 patients had been operated. All patients had radiographs at baseline, brace weaning, and follow-up, and filled in validated self-report questionnaires for evaluation of health-related quality of life. Results. 122 patients had at least one comorbid condition at follow-up. The most commonly reported diseases were: asthma, n = 14; migraine, n = 13; lower extremity disorders, n = 10; anxiety/depression, n = 9; allergy, n = 9; cardiovasular disease, n = 8; lumbar disc herniation, n = 8; neck pain or injury, n = 8; and widespread pain, n = 8. Age at bracing and at menarche, compliance, curve sizes, and the number of patients operated were not different in patients with comorbidity. Mean EQ-5D was 0.74 with comorbidity and 0.85 (normal) without (p < 0.001). Global back rating was excellent or good in 61% with comorbidity versus 78% without (p < 0.000). Fifty-seven percent versus 86% worked full-time. Those with comorbidity had lower (p < 0.001) SRS-22 scores for pain, function, self-image, and mental health, but satisfaction with bracing was not different. Final major curve size was associated only with self-image. Conclusion. Health related quality of life and work were reduced in patients with idiopathic scoliosis reporting comorbidity at long-term

We aimed to quantify the health related quality of life in a series of patients suffering a variety of different tibial injuries. Patients with previous tibial injury, randomly selected from our trauma database, who successfully completed their entire course of treatment at our institution, were recalled for final assessment. Mean time to final follow-up was 37.4 months. Statistical analysis was performed using SPSS computer software. Overall, 130 patients were evaluated. There was no significant difference in the self-care dimension between the groups. Psychological problems were common in patients with IIIb and IIIc fractures, as well as amputees, with the highest incidence in those with IIIc fractures. Patients who had undergone amputation and those with IIIb open fractures reported problems with mobility significantly more frequently than those who had IIIc type injuries. However, this could be partially attributed to the significant difference in mean age between groups, with patients sustaining IIIc injuries being younger (31.9 vs 46.9). Patients with IIIb and IIIc type fractures reported significantly more problems with pain compared with those who had undergone amputation. Interestingly, patients who had undergone fasciotomy reported pain as frequently as amputees. Regarding the VAS, only patients with closed fractures reported significantly different scores from the mean of all the other groups. These data represent the health related quality of life of patients having suffered the full spectrum of tibial injury and should be considered when determining the treatment options for these patients

Purpose: A systematic review of Health Related Quality of Life Outcomes(HRQOL) in metastatic disease of the spine and content validation of a new Spine Oncology Study Group Outcomes Questionnaire(SOSGOQ). To identify HRQOL questionnaires previously reported for spinal metastases and to validate the content of the new SOSGOQ based on the International Classification of Function and disability(ICF). Method: A systematic review identified 141 studies. Reported outcome tools were enumerated. The most commonly utilized (ESAS, Karnofsky Scale and ODI) and the SOSGOQ were linked to the ICF. Descriptive statistics examined the frequency and specificity of the ICF linkage. Linkage reliability was evaluated by inter-investigator percentage agreement. Results: The SOSGOQ contains 56 concepts, with all 4 domains of the ICF represented. 4 concepts could not be linked. There was 100% inter-observer agreement(IOA) for total number of concepts and for those ‘not covered’. 100% of concepts had ‘First and Second’ level linkage. 100% IOA exists at both ‘Component’ and “First Level’ linkage. There was 96.1% IOA at ‘Second’ Level. 33 concepts linked to Third Level with 96.9% IOA. 10 concepts linked at the Fourth Level with 100% IOA. Conclusion: The SOSGOQ includes all domains relevant for measurement of function and disability and it’s content validity is confirmed by linkage with the ICF. This new questionnaire has superior content capacity to measure disease burden of patients with metastatic disease of the spine than any instruments previously identified in the literature

Purpose: Medial compartment osteoarthritis (OA) is the most common primary osteoarthritis of the knee, but the treatment of this disease in young patients remains controversial. High tibial osteotomy (HTO), medial unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are all viable options. Gait analysis is one tool available to clinically assess knee kinematics, and may prove to be a good way of predicting functional outcomes of these different surgical procedures. The purpose of this study was to compare the knee kinematics, function, and quality of life of patients that underwent either a medial opening wedge HTO, UKA, or TKA for primary medial compartment OA.

Method: A matched prospective cohort study of patients between the ages of 45 and 65 who had undergone an HTO, UKA, or TKA for primary medial compartment knee OA was undertaken over a 3-year period. Primary outcome measures were gait variables, namely knee adduction moments, as measured through gait analysis. Secondary measures included quality of life (WOMAC), functional performance tests (six minute walk and timed-up-and-go), self-reported functional ability (LEFS), and general health (SF-36). Gait and functional performance tests were evaluated preoperatively and at 6, 12, and 24 months postoperatively. Self-reported quality of life, function and general health were assessed preoperatively and at 3, 6, 12, and 24 months post-operatively.

Results: Twenty HTOs, 19 medial UKAs, and 17 TKAs were matched for Kellgren-Lawrence grade of medial OA, age at surgery, and body mass index. Significant differences were observed between the three groups in step length and peak adduction moments at 24 months. Significant differences were observed in preoperative WOMAC pain and function scores, KOOS pain scores, and LEFS, but no significantly different outcome measures were observed postoperatively. Lateral Black-burne-Peel and modified Insall-Salvati ratios were the only significant radiographic differences observed between groups at 24 months.

Conclusion: To our knowledge, no gait analysis study exists comparing the medial opening wedge HTO to UKA or TKA. The results of this study suggest that most gait variables except step length and knee adduction moments are similar between groups. Moreover, except for patellar height, there were no major functional or radiographic differences between these groups.

A generic measure of health related quality of life was used to evaluate outcome following ACL reconstruction. This study quantifies the domains of poorer health-related quality of life and provides pre- and postoperative SF-36 scores for patients with ACL deficient knees. Pre-operative Sf-36 scores in ACL deficient knees were significantly lower than age matched normals in the physical domains of physical functioning, role-physical and bodily pain (p< 0.001). Post-operatively, SF-36 scores were significantly improved (p< 0.001) in all domains except general health and social functioning. Evaluation of the ACL injured knee and the success of reconstructive surgery has traditionally focused on an assessment of knee function. These have proven to be poor indicators of general functional outcome and health related quality of life. The purpose of this study was to use the SF-36 survey to determine whether health related quality of life in patients with ACL deficient knees differed from that of healthy individuals and whether SF-36 scores improved after undergoing ACL reconstruction. Sixty patients with ACL deficient knees underwent ACL reconstruction using arthroscopically assisted patellar tendon insertion. Prior to surgery and a minimum of two- years post-operatively, patients completed the SF-36 general Health Survey questionnaire. Pre- and post-operative SF-36 scores were compared to each other and to standard scores obtained from a healthy population of a similar age. Pre-operative Sf-36 scores in ACL deficient knees were significantly lower than age matched normals in the physical domains of physical functioning, role-physical and bodily pain (p< 0.001). Post-operatively, SF-36 scores were significantly improved (p< 0.001) in all domains except general health and social functioning. Comparison between age matched normals were significantly higher in the domains of role-emotional, vitality, mental health and general health. A generic measure of health related quality of life was used to evaluate outcome following ACL reconstruction. This study quantifies the domains of poorer health-related quality of life and provides pre- and post-operative SF-36 scores for patients with ACL deficient knees. Our finding indicates that ACL reconstruction using patellar tendon autograft with arthroscopically assisted technique improved ling term health related quality of life

To compare preoperative and postoperative Health Related Quality of Life (HRQoL) scores in operated Adolescent Idiopathic Scoliosis (AIS) patients with and without concomitant isthmic spondylolisthesis. A retrospective study of a prospective cohort of 464 individuals undergoing AIS surgery between 2008 and 2018 was performed. All patients undergoing surgery for AIS with a minimum 2-year follow-up were included. We excluded patients with prior or concomitant surgery for spondylolisthesis. HRQoL scores were measured using the SRS-22 questionnaire. Comparisons were performed between AIS patients with vs. without concomitant spondylolisthesis treated non-surgically. AIS surgery was performed for 36 patients (15.2 ±2.5 y.o) with concomitant isthmic spondylolisthesis, and 428 patients (15.5 ±2.4 y.o) without concomitant spondylolisthesis. The two groups were similar in terms of age, sex, preoperative and postoperative Cobb angles. Preoperative and postoperative HRQoL scores were similar between the two groups. HRQoL improved significantly for all domains in both groups, except for pain in patients with spondylolisthesis. There was no need for surgical treatment of the spondylolisthesis and no slip progression during the follow-up duration after AIS surgery. Patients undergoing surgical treatment of AIS with non-surgical management of a concomitant isthmic spondylolisthesis can expect improvement in HRQoL scores, similar to that observed in patients without concomitant spondylolisthesis

Acute Haematogenous Osteomyelitis (AHO) remains a cause of severe illness among children with the possibility of long-term consequences for growth and development. Previous research on sequelae from AHO rarely considers outcomes more than two years following treatment. This study aims to establish the quality of life of patients diagnosed with AHO in childhood up to 13 years after diagnosis, evaluating the impact on social, emotional, physical, and school function. Children treated for AHO between 2008–2018 at a tertiary referral centre in New Zealand were identified. PedsQL™ questionnaires were conducted via phone with either the child or primary caregiver and responses analysed. 40 patients met inclusion criteria, were contactable by phone, and consented to participate. The mean age was 7 years (range 0–15) and most were female (60%). Health related quality of life (HRQOL) was scored as a percentage with most participants scoring >80% (n=27). Those who do experience reduced quality of life following treatment for AHO were likely to complain of pain, stiffness, or anxiety. The impact of significant childhood illness on mental health was not adequately captured by the PedsQL™ but was highlighted in qualitative feedback. We conclude that the majority of children treated for AHO reported excellent health-related quality of life up to 13 years following treatment although an negative impact on mental health was reported using qualitative analysis. A refined scoring system is needed to assess the long-term impact of musculoskeletal infection

Multiligament knee injuries (MLKI) are associated with significant morbidity and healthcare requirements. The primary aim of this study is to report the patient reported outcomes measures (PROMs) after reconstructive surgery. Patients undergoing surgery for MLKI between 2014 and 2018 in the single large-volume trauma centre were included. Electronic patient records were reviewed for demographic data, details of surgery and complications. PROMs collected were EQ-5D-5L, Lysholm Knee Score (LKS), UCLA Activity and Sport and patient satisfaction. Thirty-five patients were included. Mean age was 31 years (range 16-66), and 71% were male. The most common mechanism of injury was sports-related (71%). Obesity was present in eight (23%) patients. No vascular injuries were recorded and four patients sustained nerve injuries. PROMs were available for 18 patients (51%) with a median follow up of 4.5 years. Median EQ-5D-5L was 0.78 (IQR 0.14). Median LKS was 84.5 (IQR 21) and there was no correlation with time to surgery (p=0.43). Grade of MLKI did not impact LKS (p=0.09). Fifteen patients (83%) saw a reduction in their activity level. All patients were satisfied with their surgical treatment. Recurrent instability was noted in four patients (11%). Three patients (8%) required further surgery (one revision reconstruction, one meniscectomy, one conversion to a hinged knee replacement. This study demonstrates two groups of patients who sustain MLKI: the sporting population and obese patients. Health related quality of life, functional outcomes and satisfaction are high after surgery. Time to surgery did not impact on functional outcomes

Introduction. Open fractures are complex injuries associated with substantial morbidity. These injuries are associated with harm to both physical and emotional health as well as preclusion of work, social, and leisure activities. Patient reported outcome measures (PROMs) and health related quality of life are critical indicators of successful rehabilitation following open fracture treatment. This study aimed to measure the PROMs for patients with open lower limb fractures and investigate the relationship with injury severity. Materials & Methods. A retrospective cohort study was performed at a single major trauma centre in the UK. All adult patients with an open lower limb fracture were eligible for inclusion. Patients were identified through a search of a local Open Fracture Database. Epidemiological, clinical, and fracture classification data were obtained by reviewing case notes. Lower Extremity Function Scale (LEFS) and EQ5-D were used as PROMs and measured by a postal questionnaire, alongside return to employment data. Results. A total of 73 patients responded to the questionnaire. Median LEFS was 42 (IQR 26.5 – 59.5), and median EQ5-D was 0.69 (IQR 0.48 – 0.89). There was no significant association between open fracture classification and PROMs. Over 40% of patients reported a change in employment due to their injury. Those who changed jobs had a statistically significant reduction in the EQ5-D of 0.12 (p = 0.021); no significant difference existed in LEFS. Conclusions. This study demonstrates the devastating functional impact of open fractures. This cohort of open injuries reported lower functional and quality-of-life measures compared to population norms. Injury classification was not a valuable predictor of PROMs. A substantial proportion of patients were forced to change employment due to their injury, and these patients reported a significantly lower quality of life. Further work is required to understand the factors contributing to open fracture PROMs

Abstract. Introduction. We aimed to compare the outcomes of elderly patients with periarticular distal femur or supracondylar periprosthetic fractures treated with either open reduction internal fixation or distal femoral replacement. Methods. A retrospective review of patients over 65 years with AO Type B and C fractures of the distal femur or Su type I and II periprosthetic fractures treated with either a DFR or ORIF was undertaken. Outcomes including Length of Stay, PROMs (Oxford Knee Score and EQ 5D), infection, union, mortality, complication and reoperation rates were assessed. Data on confounding variables were also collected for multivariate analysis. Patients below 65 years and extra articular fractures were excluded. Results. 23 patients (11 in DFR group and 12 in ORIF group) fulfilled inclusion criteria and were included in the analysis. There was no difference between the DFR and ORIF groups with respect to SDI, demographic variables, ASA grade, FCI, preoperative Hb and renal function. There was no difference in 30 day mortality, reoperation rates, 30 day readmission rates and LOS between the two groups. Mean follow up was 12.7 and 15.9 months respectively in the DFR and ORIF groups. At final follow up after accounting for all confounding variables on multivariate analysis, functional outcomes using OKS (adjusted mean: 29.5 vs 15.8) and Health related Quality of Life outcomes using EQ 5D (adjusted mean: 0.453 vs −0.07) were significantly better in the DFR group. Conclusion. DFR for periarticular and periprosthetic distal femoral fractures in the elderly are associated with better patient reported outcomes

Purpose. The purpose of this paper is to describe the outcomes of major hip surgery for children with cerebral palsy and communication difficulties using a validated health related quality of life measure and a validated pain score. Method. Children with hypertonic bilateral cerebral palsy (CP) GMFCS levels IV and V, 2–15 years old, having femoral + /- acetabular osteotomies for hip displacement were included if their ability to communicate necessitated the use of the CPCHILD (Caregiver Priorities and Child Health Index of Life with Disabilities) and PPP (Paediatric Pain Profile). The underlying indication for surgery was a hip migration index of more than 40% . CPCHILD and PPP questionnaires were completed face-to-face with the parents or carers at baseline, at 3 months after surgery and at 6 months after surgery. Results. There were 54 patients with a mean age of 8.8 years (SD 3.6). At baseline the mean CPCHILD was 52.1 (SD 11.8). At 3 months it was 58.5 (SD 13.1; p< 0.001). At 6 months it was 59.4 (SD 12.4; p< 0.001). This paper also describes the changes within each domain of the CPCHILD. At baseline the PPP was 12.7 (SD 7.2); at 3 months the PPP was 9.8 (SD 7.2; p< 0.01); at 6 months the PPP was 9.2 (SD 6.4; p< 0.001). Conclusion. Hip reconstruction for displacement is a major intervention for an often asymptomatic condition. This paper confirms that health related quality of life (measured by the CPCHILD) and pain (measured by the PPP) return to baseline or better than baseline within 3 months of surgery and that this is maintained at 6 months. These results should be reassuring for families and healthcare workers looking after children with severe disability undergoing surgery of this sort

A huge commitment is required from patients and families who undergo a limb reconstruction procedure using the hexapod frame. This includes turning the struts on the frame, pin site care and intensive rehabilitation. Montpetit et al (2009) discovered that function, participation, engagement in regular activities of daily living is severely impacted during the hexapod lengthening period. Due to the long duration and burden for families, it is imperative that healthcare professionals understand the impact that the hexapod frame has on functional abilities and health related quality of life (HRQL). This project involved a retrospective review of prospectively collected data on function and HRQL during two periods of time: (1) when the hexapod frame is applied on the child's lower extremity and (2) when the lengthening phase is completed, and the hexapod frame is removed. Data from 38 children (mean age: 12 years SD 3.8) who completed lower extremity reconstruction using the hexapod frame and completed either or both the Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL) and Pediatric Outcomes data Collection Instrument (PODCI) was included. Analysis included, standardized response means, the non-parametric Wilcoxon test and effect size calculation. A Wilcoxon signed rank test for those children who completed pre and post frame PODCI’;s revealed those scores were significantly greater once the hexapod frame was removed (Md=85.10, n=10) compared to during (Md=66.50, n=10) with a large effect size, r= 1.45. Similar, the PedsQL scores improved post frame removal (Md= 66.30, n=10) compared to during treatment (Md = 53.34, n=10), with a medium size effect, r= 0.62. All subtests improved once the frame was removed. This study provides essential insights into the burden of the hexapod frame for children and provides valuable information for all allied healthcare professionals targeted interventions for health domains. This study shows that children's function improves once the hexapod frame is removed. However, this study highlights the importance for all healthcare professional to address health domains for the duration of the hexapod procedure where the child scored lower e.g. sports and physical function, pain and comfort, happiness from the PODCI. The PedsQL identified lower mean scores in physical and emotional function

Periprosthetic joint infection is a significant complication of total hip arthroplasty. The PRSThesis of Antibiotic Loaded Acrylic Cement (PROSTALAC) system can improve health related quality of life during a two step treatment approach for infection resolution. We investigated quality of life with the PROSTALAC in situ and also compared subjects who underwent second stage surgery with those who retained the PROSTALAC on a long term basis. Twenty nine subjects were enrolled pre-PROSTALAC insertion, recording demographics, physical demand level and comorbidities. Subjects were then followed out to 24 months with either the PROSTALAC in situ or post revision for those who underwent the second stage surgery. Quality of life was evaluated using the Western Ontario McMaster Osteoarthritis Index (WOMAC) and RAND 36-Item Health Survey (RAND-36). Infection resolution was also determined for all subjects enrolled. Three subjects died and 22/26 (84%) completed the evaluation. Overall 26 (85%) infections resolved. Following PROSTALAC insertion, WOMAC pain and function scores improved within three to six months and did not change out to 24 months. Physical function, bodily pain and vitality also significantly improved within three to six months postoperatively. Only seven (32%) subjects underwent second stage surgery. These individuals were more likely to be high demand (p=0.03) and trended towards being younger, male, with fewer comorbidities and lower BMI (p<0.10). There was no difference in WOMAC scores at 24 months between those who underwent second stage revisions and those who retained the PROSTALAC. The use of a PROSTALAC implant improves health related quality of life. Long term retention of the PROSTALAC implant may be appropriate for low demand patients and considered for potentially high risk surgical candidates

To assess the clinical and radiologic outcome of MM patients with thoracic spine involvement and concomitant pathologic sternal fractures with a resultant severe sagittal plane deformity. A prospective cohort study (n=391) was performed over a 7-year period at a national tertiary referral centre for the management of multiple myeloma with spinal involvement. Clinical, serological and pathologic variables, radiologic findings, treatment strategies and outcome measures were prospectively collected. Pre-treatment and post-treatment clinical outcome measures utilised included EQ-5D, VAS, ODI and RMD scoring systems. 13 MM patients presented with a severe symptomatic progressive sagittal plane deformity with a history of pathologic thoracic compression fractures and concomitant pathologic sternal fracture. All patients with concomitant sternal fractures displayed the radiographic features and spinopelvic parameters of positive sagittal malalignment and attempted clinical compensation. All patients had poor health related quality of life measures when assessed. Pathologic sternal fracture in a MM patient with thoracic compression fractures is a risk factor for the development of a severe thoracic kyphotic deformity and sagittal malalignment. This has been demonstrated to be associated with a very poor health related quality of life

This study aims to determine satisfaction rates after hip and knee arthroplasty in patients who did not initially respond to PROMs, characteristics of non-responders, and contact preferences to maximise response rates. We performed a prospective cohort study of 709 patients undergoing THA and 737 patients undergoing TKA in a single centre in 2018. EQ-5D health related quality of life score and Oxford Hip/knee scores (OHS/OKS) were completed preoperatively and at 1year postoperatively via post when satisfaction was also assessed. Univariate, multivariate and receiver operator curve analysis were performed. 151/709 (21.2%) hip patients were non-responders, 83 (55.0%) of whom were contactable. 108/737 (14.6%) knee patients were non-responders, 91 (84.3%) of whom were contactable. There was no difference in satisfaction after arthroplasty between initial non-responders and responders for hips (74/81 vs 476/516, p=0.847) or knees (81/93 vs 470/561, p=0.480). Initial and persistent non-response was associated with younger age, higher BMIs and significantly worse preoperative PROMS for both hip and knee patients (p=0.05). Multivariate analysis demonstrated that younger age, higher BMI and poorer pre-operative OHS were independently associated with persistent non-response to hip PROMs (p<0.05). For the entire cohort (n=1352) patients <67 years were less likely to respond to postal PROMs with OR 0.63 (0.558 to 0.711). Using a threshold of >66.4 years predicted a preference for contact by post with 65.4% sensitivity and 68.1% specificity (AUC 0.723 (0.647-0.799 95%CI, p<0.001)). Most initial non-responders were ultimately contactable with effort. Satisfaction rates were not inferior in patients who did not initially respond to PROMs

Purpose: To compare the clinical outcomes of patients surgically treated for end stage ankle arthritis using total ankle arthroplasty or ankle arthrodesis. Method: This is a single center clinical outcome study of the surgical treatment of patients with end stage ankle arthritis (n=81) using an ankle arthrodesis or total ankle arthroplasty. Clinical outcome was assessed using health related quality of life (SF36v2) and joint specific (Ankle Osteoarthritis Scale, American Orthopedic Foot and Ankle Hindfoot Scale and the AAOS Foot and Ankle Baseline Questionnaire(version 2000)) outcome scores. Complications were recorded as well. Results: Preoperatively, all patients had significant physical and psychological morbidity. There was a significant improvement in the health related quality of life and the joint specific clinical outcome scores at 1, 2 and 3 years follow up (p-value.05) Complications included 5 (10%) non union, in the ankle arthrodesis cohort and 2 (6.7%) revisions for aseptic loosening in the total ankle arthroplasty cohort. Conclusion: The results of this study indicate that surgical treatment of end stage ankle arthritis with ankle arthrodesis or total ankle arthroplasty equally improve clinical outcome in the short term with acceptable and similar complication rates

The purpose of this study was to compare the clinical outcome of patients treated surgically for end stage ankle arthritis using a total ankle arthroplasty or ankle arthrodesis. This is a multicentered prospective clinical outcome study of the surgical treatment of patients with EAA using an ankle arthrodesis (n= 117) or total ankle arthroplasty (n= 210). Clinical outcome was assessed using health related quality of life (SF36v2) and joint specific (Foot Function Index, Ankle Osteoarthritis Scale, American Orthopedic Foot and Ankle Hindfoot Scale and the AAOS Foot and Ankle Baseline Questionnaire(version 2000)) outcome scores. Preoperatively, all patients had significant physical and psychological morbidity. All symptom and functional SF36 subscales were approximately two standard deviations below normal population scores. Approximately 25% of patients were three standard deviations below population values, indicating increased risk of mortality. There was no evidence that age or gender influenced the level of disability. There was a significant improvement in the health related quality of life and the joint specific clinical outcome scores at six and twelve months follow up but no consistent difference was noted between the two cohorts. This is the first multicentered prospective clinical outcome study that demonstrates equal efficacy for early follow up of patients treated for EAA with total ankle arthroplasty or ankle arthrodesis

The purpose of this study is to assess the clinical outcome and gait analysis of a new technique for ankle arthrodesis using a Fibular Sparing Z Osteotomy (FSZO). The FSZO technique for ankle arthrodesis utilises a lateral approach where the fibula is osteotomised and reflected posteriorly on a soft tissue hinge to allow easy access to the ankle joint for an anatomic arthrodesis. Outcome assessment at six months follow up included health related quality of life (SF36) and joint specific (American Orthopedic Foot and Ankle Society Ankle-Hindfoot, Ankle Osteoarthritis Scale, Foot Function Index) clinical outcome scores. Gait Analysis was completed using the Walkabout Portable Gait Monitor® which includes a wireless gait belt housing a triaxial arrangement of accelerometers, resting behind the lumbar vertebrae, approximately at position of centre of mass to quatintfy surgery, lurch and functional limb length difference (LLD). There was a significant improvement in the health related quality of life and the joint specific clinical outcome scores at six months follow up. The six month gait study preliminary analysis showed improvement in some parameters of gait but worsening in others. The FSZO ankle arthrodesis technique provides improvement in clinical outcome scores and certain gait parameters at early follow up

One potential approach to addressing the current hip and knee arthroplasty backlog is via adoption of surgical prioritisation methods, such as use of pre-operative health related quality of life (HRQOL) assessment. We set out to determine whether dichotomization using a previously identified bimodal EuroQol Five-Dimension (EQ-5D) distribution could be used to triage waiting lists. 516 patients had data collected regarding demographics, perioperative variables and patient reported outcome measures (pre-operative & 1-year post-operative EQ-5D-3L and Oxford Hip and Knee Scores (OHS/OKS). Patients were split into two equal groups based on pre-operative EQ-5D Time Trade-Off (TTO) scores and compared (Group1 [worse HRQOL] = −0.239 to 0.487; Group2 [better HRQOL] = 0.516 to 1 (best)). The EQ5D TTO is a widely used and validated HRQOL measure that generates single values for different combinations of health-states based upon how individuals compare x years of healthy living to x years of illness. We identified that those in Group1 had significantly greater improvement in post-operative EQ-5D TTO scores compared to Group2 (Median 0.67vs.0.19; p<0.0001 respectively), as well as greater improvement in OHS/OKS (Mean 22.4vs16.4; p<0.0001 respectively). Those in Group2 were significantly less likely to achieve EQ-5D MCID attainment (OR 0.13, 95%CI 0.07–0.23; p<0.0001) with a trend towards lower OHS/OKS MCID attainment (OR 0.66, 95%CI 0.37–1.19; p=0.168). There was no statistically significant difference in adverse events. These finding suggest that a pre-operative EQ-5D cut-off of ≤0.487 for hip and knee arthroplasty prioritisation may help to maximise clinical utility and cost-effectiveness in a limited resource setting post COVID-19