No Association Between Patient Reported Outcomes and Ankle and Hindfoot Osteoarthritis Radiographic Severity

Category: Ankle Arthritis; Ankle Introduction/Purpose: The Kellgren-Lawrence scale has been used as a valid and reliable system to grade osteoarthritis. This study seeks to examine the association between preoperative Kellgren-Lawrence (KL) scale grade of ankle or hindfoot arthritis and postoperative outcome measures (PROMs) in patients undergoing total ankle arthroplasty (TAA), ankle arthrodesis (AA), or hindfoot arthrodesis. Methods: A retrospective review was conducted of 254 ankles (250 patients) with minimum 6-month follow-up, undergoing TAA, AA, or hindfoot arthrodesis from 2016-2022. Patients were identified by having undergone surgery via CPT codes (27702, 27870, 27815, or 27825). 131 patients (51.6%) underwent TAA. Of patients undergoing various ankle and hindfoot fusions, involved joints were tibio-talar (n=83; 32.7%), sub-talar (n=46; 18.1%), talo-navicular (n=15; 5.9%) and calcaneocuboid 1 (0.3%). Preoperative KL grade of the joint undergoing arthrodesis/arthroplasty was evaluated. Data collected included demographics, medical history, PROMs (FAOS, FAAM, VAS, SSS-8, PDI, and PCS), postoperative complications, readmission and reoperation rates. The final cohort mean age was 58.26 (range 18-85) years with mean BMI 31.97 (range 17.85-61.38) kg/m 2 and mean follow-up of 1.69 (range 0.50-6.13) years. Results: The overall cohort was primarily KL grade 3 and 4 at each of the examined joints. There were no significant differences in demographics or procedure performed between groups, with the exception of age, which was statistically significantly associated with an increased KL grade for the TN joint (p=.006). Preoperatively, the tibiotalar joints with a KL grade of 3 were associated with significantly higher preoperative SSS-8 scores (p=.002). A preoperative KL grade of 2 at the subtalar joint was associated with significantly lower preoperative FAOS recreation scores (p=.030). Postoperatively, there was no statistically significant difference in patient reported outcomes with any of the examined joints KL grade. Lastly, there was no statistically significant association between KL score of any joint and postoperative complication, readmission, or reoperation. Conclusion: There was no association between preoperative Kellgren-Lawrence grade and post-operative PROMs or mean 1.69 year outcomes following TAA, AA, or hindfoot arthrodesis. Surgeons should be aware that, at least for patients indicated for TAA or ankle/hindfoot arthrodesis, preoperative KL grade does not seem to impact short term PROM scores.