Complica)onratesandshort-termoutcomessimilara4erhammertoe

correc)oninolderpa)ents

ClaireMuellerMS3,StephanieBodenMS4,JasonBariteauMD

AOFASAnnualMee)ng2017July12–15

SeaHle,Washington

DisclosuresNO CONFLICTS TO DISCLOSE

Complica/onratesandshort-termoutcomessimilara5erhammertoecorrec/oninolderpa/ents

ClaireMuellerMS3

StephanieBodenMS4JasonBariteauMD

OurdisclosuresintheFinalAOFASMobileApp.

Wehavenopoten/alconflictswiththispresenta/on.

HammertoeCorrec/on•  Hammertoedeformi/esareoneof

themostcommonlessertoedeformi)esandaremorecommonintheelderlypopula/on1,2

•  Es/matedeconomicburdenoffootandanklesurgeriesforUSMedicarepopula/onwas$11billionin2011,up38.2%since20003–  Hammertoerepairwasthetop

procedure

•  Geriatricpa/entsareatincreasedriskofsurgicalcomplica)ons4

•  Nostudiesexistthatlookspecificallyatoutcomesofhammertoecorrec)onsurgeryinthegeriatricpa)entpopula)on

BelaTDA,PhisitkulP.EconomicburdenoffootandanklesurgeryintheUSMedicarepopula/on.FootAnkleInt.2014;35(4):334-340.

Kwon,JY,DeAsla,RJ.Theuseofflexortoextensortransfersforthecorrec/onoftheflexiblehammertoedeformity.FootAnkleClinNAm.2011;16:573-582.

Purpose

Todetermineifolderpa/ents(>65yearsold)haveinferioroutcomescomparedtoyoungerpa/entsa5ersurgicalcorrec/onofhammertoe

deformi/es

Methods•  DesignandPopula/on:

–  Retrospec/veobserva/onalstudy–  Allpa/entswhounderwentsurgical

correc/onofhammertoe•  August1,2014-December1,2016

–  Pa/entsdividedinto2groups:•  >65yearsoldor<65yearsold

•  Outcomesmeasured:–  VisualAnalogueScale(VAS)

•  Pre-op,6monthspost-op,12monthspostop

–  ShortFormHealthSurvey(SF-36)•  Pre-op,6monthspost-op,12monthspostop

–  Postopera/vecomplica/ons

•  Sta/s/cs:–  MeanimprovementsandSEM

forallVAS,PCS,andMCSsurveysateach/mepointforbothgroups

–  Resultsassessedforsta/s/calsignificanceusingapairedt-test

–  Mul/plelinearregressionmodelsusingseveralcovariates•  Age,smoking,diabetes,

rheumatoidarthri/s,bloodthinneruse

–  Logis/cregressionmodelsandoddsra/os

Results•  58pa/entsenrolled•  47pa/entshadatleast6

monthsoffollow-updata(81.03%follow-uprate)–  7males,40females–  Averageage60.9yearsold

•  Nosignificantdifferencebetweenyoungerandoldergroups

•  Nocovariatestestedshowedanysignificantassocia/onwithchangeinVAS,PCS,orMCS

CovariatesTested <65years(n=26)

>65years(n=21)

p-value

Eversmoker,n(%) 4(15.4) 5(10.6) 0.486

Diabetesorpre-diabetes,n(%)

3(6.4) 1(2.1) 0.617

Rheumatoidarthri)s,n(%)

3(6.4) 2(4.3) 1.000

BMI,mean(95%CI) 29.7(27.1,32.3)

27.9(25.3,30.5)

0.301

Onbloodthinners,n(%) 7(15.6) 8(17.8) 0.347

StudyPopula)on <65yearsold >65yearsold

Par)cipants(toes) 26(37) 21(39)

Meanageinyears(range) 52.69(25-64) 70.95(65-82)

Meanfollow-upinmonths 8.5 10.3

0

1

2

3

4

5

6

6 months 12 months

Mean Improvement in VAS Score from Baseline

< 65 years old ≥ 65 years old

OverallsignificantimprovementinmeanVASscores.NosignificantdifferenceinmeanimprovementofVASscoresbetween<65yearold

and>65yearoldgroupspost-opera/vely

VisualAnalogueScale(VAS)Scores

0

1

2

3

4

5

6

<65yearsold >65yearsold

Mea

n VA

S

Mean VAS Scores

Pre-op 6-months 12months

>

0

2

4

6

8

10

12

14

16

18

20

6 months 12 months

Mea

n im

prov

emen

t in

PCS

(poi

nts)

Mean Improvement in PCS

< 65 years old

≥ 65 years old

OverallsignificantimprovementinmeanPCSinbothagegroups.NosignificantdifferenceinmeanimprovementofPCSbetween<65yearold

and>65yearoldgroupspost-opera/vely

SF-36PhysicalComponentScore(PCS)

0

10

20

30

40

50

60

70

80

90

100

< 65 years old > 65 years old

Mea

n PC

S (p

oint

s)

Mean PCS

Pre-op 6 months 12 months

Complica/onsComplica)onrateperhammertoecorrec)on

<65yearsold >65yearsold pvalue

Overallcomplica)onrate

13.5%(5/37) 10.3%(4/39) 0.665

Complica)onsreported

Valgusmalalignment 2.7%(1/37) 0.0%(0/39)

DVT/PE 5.4%(2/37) 0.0%(0/39)

Pain/hardwareremoval

0.0%(0/37) 2.6%(1/39)

Other 0.0%(0/37) 5.1%(2/39)

Recurrence 0.0%(0/37) 2.6%(1/39)

Revision 5.4%(2/37) 0.0%(0/39)

Nosignificantdifferenceincomplica)onratesbetween<65yearoldand>65yearoldgroups

Strengths•  >80%follow-uprate•  Representa/vestudy

popula/on•  Validatedques/onnaires

(VASandSF-36)•  Singlesurgeon

Limita)ons•  Retrospec/vedesign•  Smallstudypopula/on•  Suscep/bletotypeIIerror•  Possibilityofrecallbias

Evalua/on

FutureDirec)ons:•  Examineoutcomesinlargercohort•  Compareradiologicoutcomesofhammertoe

deformi/espre-andpost-opera/vely

Conclusions

•  Outcomesofsurgicalcorrec/onofhammertoedeformi/esinpa/ents65andolderwerenotsignificantlydifferentfromoutcomesinpa/entsundertheageof65

•  OverallimprovementinVASandPCSoftheSF-36wassta)s)callysignificantforallpar/cipants

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OrthopSurg.2011;19(8):505-514.2.  Kwon,JY,DeAsla,RJ.Theuseofflexortoextensortransfersforthecorrec/onof

theflexiblehammertoedeformity.FootAnkleClinNAm.2011;16:573-582.3.  BelaTDA,PhisitkulP.EconomicburdenoffootandanklesurgeryintheUS

Medicarepopula/on.FootAnkleInt.2014;35(4):334-340.4.  SobelE,GiorginiRJ.Surgicalconsidera/onsinthegeriatricpa/ent.ClinPodiatr

MedSurg.2003;20(3):607-26.5.  Sung,W,Weil,L.Jr.,Weil,LS.Sr.Retrospec/vecompara/vestudyofopera/ve

repairofhammertoedeformity.FootAnkleSpec.2014;7(3):185-92.6.  Kernbach,KJ.Hammertoesurgery:arthroplasty,arthrodesisorplantar

platerepair?ClinPodiatrMedSurg.2012;29(3):355-366.7.  Catena,F,Doty,JF,Jas/fer,J,Coughlin,MJ,Stevens,F.Prospec/vestudyof

hammertoecorrec/onwithanintramedullaryimplant.FootAnkleInt.2014;35(4):319-325.