“I could have a proper ankle” – a qualitative study of patients’ perceptions of total ankle replacement and ankle fusion surgery

Journal of Foot and Ankle Research

Research

Claire L. Brockett¹  Lara S. Chapman²  Heidi J. Siddle²  Anna M. Anderson³  Sue Watson⁴  Jane Klugerman⁴  Deborah Antcliff⁵  Anne-Maree Keenan⁶ 

[1] Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK;Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK;Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK;School of Healthcare, University of Leeds, Leeds, UK;Leeds Institute of Health Sciences, University of Leeds, Leeds, UK;Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK;School of Healthcare, University of Leeds, Leeds, UK;Bury Integrated Pain Service, Bury Care Organisation, Northern Care Alliance NHS Foundation Trust, Bury, England, UK;School of Medicine, Keele University, Keele, UK;School of Healthcare, University of Leeds, Leeds, UK;Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK;

关键词: Total ankle replacement;    Ankle fusion;    Patient education;    Rehabilitation;   

DOI  :  10.1186/s13047-022-00595-8

 received in 2022-09-02, accepted in 2022-12-01,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundEnd-stage ankle osteoarthritis typically causes severe pain and impaired function. Surgical treatment involves total ankle replacement (TAR) or ankle fusion. Definitive evidence about which procedure is optimal is lacking. No previous studies have thoroughly explored patients’ experiences across the entire TAR/ankle fusion pathway. This study aimed to address this gap by exploring perceptions of surgery, education, rehabilitation and outcomes among patients who had undergone TAR or ankle fusion.MethodsSeven participants were purposively selected from an orthopaedic centre in northern England (3 females, 4 males). Participants had undergone primary TAR without revision (n = 2), TAR requiring revision (n = 3) or ankle fusion (n = 2). Each participant completed a single semi-structured interview. Interviews were digitally recorded, transcribed verbatim and analysed thematically.ResultsThree themes, each with two subthemes, were identified: decision-making (seeking help; surgical options), perceptions of support (information/education; clinical support) and impact on the individual (personal circumstances and beliefs; post-operative outcomes). Pain affecting participants’ valued activities was key to their decision to seek help. Participants’ decision between TAR and ankle fusion was influenced by multiple factors. Concerns regarding the lack of joint flexibility following fusion were highlighted, with some participants perceiving TAR as a “proper ankle” that would enable them to avoid limping. Participants obtained information from various sources, with most feeling that the education from their care team was inadequate. Participants’ individual circumstances and beliefs influenced their decision-making and perceptions of their post-operative outcomes. Finally, whilst most participants were pleased with their outcomes, some experienced substantial ongoing problems such as difficulty walking and chronic pain.ConclusionsThis study demonstrates the importance of providing adequate education about TAR and ankle fusion to enable patients to make informed decisions. Most participants felt that the education and clinical support they received did not fully meet their needs. Participants’ personal circumstances and beliefs had a strong influence on their decision-making and perceptions of their post-operative outcomes, highlighting the need to personally tailor education and clinical support. Future work with a larger sample of patients and other key stakeholders is required to develop consensus-based guidelines on pre- and post-operative support for patients undergoing TAR/ankle fusion.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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