Patient-reported joint status, quality of life, and activity level with the end-stage hindfoot and ankle osteoarthritis

  • Tim Žlak
  • Nik Žlak
  • Matej Drobnič
Keywords: Ankle; Hindfoot; Osteoarthritis; Fusion; Subjective joint status; Quality of Life; Activity level


Purpose: To evaluate and associate the preoperative hindfoot/ankle radiographs and the patient-reported outcome measures - PROMs (subjective joint status, quality of life, activity level) prior to hindfoot and/or ankle fusions due to an end stage osteoarthritis (OA).

Methods: In this retrospective analysis, the hospital records of patients admitted for a hindfoot and/or ankle surgery over a 5-year period were reviewed. Inclusion selection identified 144 adults (161 feet) who underwent ankle (ATC), subtalar (ST), talonavicular (TN), and calcaneocuboid (CC) fusion or a combination of thereof. Patients’ Foot and Ankle Outcome Score (FAOS), European Quality of life in Five-Dimensions and visual analogue score (EQ-5D-TTO and EQ-VAS), Tegner Activity Scale (TAS) and their preoperative standing radiographs were analyzed and compared across the following subgroups: (a) isolated ATC fusion (ATC_F); (b) isolated ST fusion (ST_F); (c) ATC fusion with concomitant ST fusion (ATC_ST_F); (d) ST fusion with concomitant TN or CC fusion (ST_CONC_F); (e) complete hindfoot (ST + TN ± CC) and ATC joint (ATC_ST_CONC _F) fusion. The patients’ PROMs were additionally compared to the general population values.

Results: There was a marked subjective ankle dysfunction (average FAOS cumulative – 40) decreased quality of life (average EQ-5D-TTO – 0.41, average EQ-VAS – 56) and activity level (mean TAS – 2) across all the patients’ subgroups in comparison to the general population (FAOS cumulative – 87, EQ-5D-TTO – 0.81, EQ-VAS – 80, and TAS – 5). Analysis within the subgroups revealed a significant difference between: ATC_F and ST_CONC_F in FAOS Symptoms (36 vs. 55); ATC_F and ST_F in EQ-5D VAS (61 vs. 50) and TAS (2 vs. 3). Multivariate linear regression models revealed a significant negative correlation between older age, female gender, higher levels of radiographic OA in ATC and Chopart joints, and longer symptom duration toward some of the preoperative PROMs

Conclusion: Patients suffering from an end-stage hindfoot or ankle OA experience a profound deterioration in subjective ankle function, quality of life, and activity levels. Older age, female gender, longer symptoms duration, and higher levels of radiographic OA in ATC or Chopart joints were the negative predictors for their preoperative PROMs.


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Author Biographies

Tim Žlak

Department of orthopedic surgery, General hospital Celje, Celje, Slovenia

Nik Žlak

Department of orthopedic surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia

Chair of Orthopedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

Matej Drobnič

Department of orthopedic surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia

Chair of Orthopedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia


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