To evaluate patient satisfaction and expectations of surgery following forefoot arthroplasty.
Between October 1993 and June 1999, forefoot arthroplasty (Kate/Kessel/Kay procedure) was performed or directly supervised by the senior author (D. McBride) in a cohort of 55 patients. All had inflammatory arthritis and had failed non-operative management. The clinical result was assessed using a self-administered patient satisfaction questionnaire. The questionnaire asked patients to rate their level of satisfaction in terms of pain relief, wound healing, stiffness and appearance. The patients expectations from the surgery in terms of their level of disability and the achievement of the operation in addition to their pain experience following their operation was assessed.
Median time to follow-up was 41 months (range seven to seventy-seven). Forty-three of the 55 patients returned the completed questionnaire. The median age at operation of the respondents was 59 years (range 42 to 69) compared with 49 years (range 44 to 63) for the non-respondents. Of the 43 respondents, 30 were female and 13 male. In terms of their expectations of the surgery, 20 (47%) stated that the operation had achieved what they had expected while 10 (23%) considered the operation to have achieved more than they had expected. The level of disability following their operation was as expected in 21 (49%), more than expected in 11 (26%) and less than expected in four (9%). 23 (55%) noted no change to their walking capacity while it had increased in 11 (26%) and decreased in eight (19%). There were two wound haematomas, five superficial wound infections and three cases of delayed wound healing which extended the post-operative hospital stay. Seventy-nine percent of patients however reported complete satisfaction with their wound healing. In those patients that had reported having had pain (n=31) at some time following their operation, two (7%) had experienced it for less than seven days, four (13%) for between one and four weeks, one (3%) for between one and three months and 23 (77%) for more than three months.
Overall patients were generally satisfied with their operation in terms of pain relief, wound healing and appearance. Additionally, in the majority of patients, the achievements of the procedure and the associated disability were as expected. Previous authors have outlined the various surgical factors, which are said to lead to a good outcome. Whilst it is important to bear these factors in mind we have found that some of our patients appeared to have a good result when these criteria were not met. While other patients meeting these criteria were not necessarily satisfied. This suggests areas for further research.
