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
Resources1. ShirzadK,KiesauCD,DeorioJK,ParekhSG.Lessertoedeformi/es.JAmAcad
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.
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