Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients' Perspective
Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients' Perspective
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DOI：
10.1177/10711007211004447
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发表时间：
2021-04-23
影响因子：
2.7
通讯作者：
Pinsker, Ellie B.
中科院分区：
文献类型：
--
作者：
Conlin, Catherine;Khan, Ryan M.;Pinsker, Ellie B.
背景：全踝关节置换术（TAR）和踝关节融合术是治疗终末期踝关节炎的有效方法。比较研究阐明了治疗结果的差异;然而，文献缺乏证据证明哪些结果对患者重要。本研究的目的是调查患者同时接受TAR和踝关节融合的生活经历。方法：本研究采用质性描述法。个体选自TAR和/或踝关节融合患者队列（n = 1254）。符合条件的患者为会讲英语的TAR患者和对侧踝关节融合患者，且距最近一次踝关节重建至少1年。外科手术由一位经验丰富的外科医生进行，半结构化访谈由一位研究人员在私人医院或通过电话进行。收集踝关节骨关节炎量表（AOS）评分、X线片和辅助外科手术以表征患者。通过定性数据分析得出主题。结果：纳入10名成人（8名男性，2名女性），年龄59至90岁。对于大多数患者，两种手术的平均AOS疼痛和残疾评分相似。参与者讨论了每个重建踝关节的看法。踝关节融合被认为是稳定和强大的，但也僵硬和妥协的平衡。TAR被认为是灵活的，更像一个“正常的脚踝”，尽管患者对他们的TAR在不平坦的地面上“转动”表示担忧。个人应用这些知识来促进运动，特别是在第一步和位置之间的过渡。他们描述了需要仔细放置脚和注意环境，以避免潜在的挑战。结论：本研究提供了对TAR和踝关节融合患者经验的深入了解。在这个不寻常但有限的患者群体中，我们发现每种踝关节重建术通常都有不同的特点、优点和缺点。大多数与会者明确表示倾向于他们的第三次评估报告。这些发现可以帮助临床医生更好地为患者提供TAR和踝关节融合后的预期建议，并通过更好地为患者获取有意义的结局来改善患者报告的结局指标。
Background: Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients' experiences of living with both a TAR and ankle fusion. Methods: This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. Results: Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a "normal ankle," though patients expressed concerns about their TAR "turning" on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. Conclusion: This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients.