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Background: Both an open cheilectomy with a Moberg osteotomy and percutaneous cheilectomy have been successfully used to treat hallux rigidus and preserve motion. However, there have been no studies that have compared these 2 procedures using validated patient-reported outcomes such as the Patient Reported Outcome Measurement Information System. Methods: A retrospective review of hallux rigidus patients between January 2016 and July 2021 collected 48 percutaneous cheilectomy (PC) patients and 71 open cheilectomy with Moberg (OCM) patients. Preoperative and minimum 1-year postoperative PROMIS scores were collected. Results: The OCM and PC cohorts did not have significant differences in their postoperative PROMIS scores. Both cohorts had modest but significant improvements postoperatively in the physical function, pain interference, and pain intensity domains. The OCM group had a larger degree of improvement in physical function, pain interference, and pain intensity ( P = .015, .011, .001, respectively). No significant difference was identified in the reoperation rate. Conclusion: Patients undergoing an OCM had worse preoperative PROMIS scores and a modestly greater change in patient-reported outcomes than patients undergoing a PC. Level of Evidence: Level III, retrospective review.

Background: Hallux valgus deformity affects more than 35% of people aged ≥65 years. Surgical correction in this population can be more complicated because of poor bone quality, worse deformity, and postoperative recovery challenges. The purpose of this study was to compare the radiographic and clinical outcomes of patients aged ≥65 years who underwent either open Lapidus or minimally invasive chevron Akin osteotomy for bunion correction. Methods: A retrospective review identified 62 patients aged ≥65 years who were treated surgically for hallux valgus with at least 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores (physical function and pain interference). Preoperative and at least 6-month postoperative radiographs were measured for the hallux valgus angle and intermetatarsal angle. PROMIS scores were obtained preoperatively and at 1 and/or 2 years postoperatively. Differences in demographic, clinical, and radiographic outcomes were assessed using the Mann Whitney U test and P values were adjusted for a false discovery rate of 5%. Results: There was no difference between the MIS and open cohorts in pre- or postoperative radiographic measurements or clinical outcomes at any time point. At 1 year postoperatively, both groups had statistically significant improvements in the PROMIS pain interference domain but only the MIS group had a statistically significant improvement in the PROMIS physical function domain. Clinical significance was equivocal. At 2 years postoperatively, there were clinically and statistically significant improvements in the PROMIS pain interference and physical function domains for the open and MIS groups. Conclusion: Patients in both surgical groups had improvement in radiographic measurements and 2-year PROMIS scores, although there was no clinical or statistical difference found between groups. MIS and open surgical techniques appear to be safe and effective in correcting hallux valgus in older patients; however, patients may need to be counseled that maximum improvement after surgery may take more than 1 year. Level of Evidence: Level III, retrospective cohort study.

Introduction/Purpose: In an ever-changing healthcare landscape, patient-reported outcomes (PROs) are becoming more important for reimbursement and evaluating the success of surgical procedures. Unfortunately, it is unclear which PROs correlate best with clinical improvement. The patient acceptable symptom state (PASS) asks the patient whether or not their outcome is acceptable at a particular post-operative time point. Recently, the use of this metric has gained traction within the foot and ankle literature. To our knowledge, this is the first study that aims to establish PASS thresholds for Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients who underwent operative intervention for hallux rigidus. Methods: A retrospective review of prospectively collected data within an institutional registry was performed. We identified 174 patients treated for hallux rigidus between February 2019 and March 2021 with at least 2-year post-operative PROMIS scores. Chart review was performed to obtain demographic information and to confirm the surgical procedures that were completed. Two-years post-operatively, patients answered two PASS anchor questions (Satisfaction, Delighted-Terrible scale) with Likert- scale responses, which was collected along with pre-operative and 2-year post-operative PROMIS scores via the registry. After patient’s answers to the Satisfaction and Delighted-Terrible scales were recategorized into binary responses, PASS thresholds were determined using the maximum Youden Index and a 95% confidence interval was quantified using 2000 bootstrapped iterations. Differences in patient and surgical characteristics between patients who met or did not meet the PASS threshold were compared using independent samples t-test and Pearson chi square. Statistical significance was established at an alpha of 0.05. Results: There was excellent association between PASS thresholds and the PROMIS domains of Physical Function (48.6, AUC=0.82) and Pain Interference (52.1, AUC =0.86). Overall, 125/174 (71.8%) and 105/174 (60.3%) patients met the threshold for Physical Function (PF) and Pain Interference (PI), respectively. For the PF and PI domains, age, BMI, method of cheilectomy and use of Akin/Moberg osteotomy did not impact a patient’s likelihood of meeting the PASS threshold. For the PF domain and the PI domain stratified by the Delighted-Terrible scale, women were more likely to meet the PASS threshold than men (63.2% vs. 36.8%, p = 0.057 and 73% vs. 45%, p =0.023, respectively). Lastly, patients with a higher pre-operative PF score had a higher chance of meeting the PASS threshold (p < 0.001). Conclusion: Following operative intervention to treat hallux rigidus, pre-operative PROMIS scores were strongly associated with a patient’s likelihood of meeting the PASS threshold. After surgical intervention for hallux rigidus, less than 75% of the patients felt their outcome was acceptable; however, the PASS threshold for PF was lower than population average, so it may not be necessary for patients to reach normal physical function levels post-operatively in order to have an acceptable outcome.

Introduction/Purpose: Surgical interventions to correct hallux valgus have been shown to improve patient reported outcomes (PROs); however, many of these instruments do not measure a patient’s subjective outcome experience. The patient acceptable symptom state (PASS) is defined as the symptom threshold that a patient must reach to be satisfied with the outcome of their surgery. PASS thresholds have been defined for hallux valgus correction using American Orthopaedic Foot & Ankle Society (AOFAS) scores; however, no studies have used a validated PRO metric. This is the first study that aims to establish PASS thresholds for Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients following operative intervention for hallux valgus. Methods: A retrospective review of prospectively collected data within an institutional registry was performed. We identified 291 patients treated for hallux valgus with or without second hammertoe correction between February 2019 and March 2021 with at least 2-year post-operative PROMIS scores. Chart review was performed to obtain demographic information and to confirm the surgical procedures completed. Two-years post-operatively, patients answered two PASS anchor questions (Satisfaction, Delighted-Terrible scale) with Likert-scale responses, which was collected along with pre-operative and 2-year post-operative PROMIS scores via the registry. After patient’s answers to the Satisfaction and Delighted-Terrible scales were recategorized into binary responses; PASS thresholds were determined using the maximum Youden Index and a 95% confidence interval was quantified using 2000 bootstrapped iterations. Differences in patient and surgical characteristics between patients who met or did not meet the PASS threshold were compared using independent samples t-test and Pearson chi square. Results: There was excellent association between PASS thresholds and the PROMIS domains of Physical Function (50.3, AUC=0.86) and Pain Interference (51.5, AUC=0.86). Overall, 204/291 and 205/291 patients met the threshold for Physical Function (PF) and Pain Interference (PI), respectively. For both PROMIS domains, a lower BMI was associated with a higher likelihood of meeting the PASS threshold (p=0.002 for PF, p=0.032 for PI). For the PF domain, Lapidus patients were more likely to meet the PASS threshold (p=0.05), and patients with first MTP fusion were less likely to meet the PASS threshold (p=0.004). Meeting the PASS threshold wasn’t impacted by the concomitant correction of a second hammertoe. Lastly, patients with a higher pre-operative PF score had a greater chance of meeting the PASS threshold (p < 0.001). Conclusion: This is the first study to define a PASS threshold for hallux valgus correction using PROMIS scores, a validated outcomes measure. Pre-operative PROMIS scores, patient BMI, and the type of procedure performed impacted a patient’s likelihood of meeting the PASS threshold. These results may be helpful in counseling and educating patients on their chances of obtaining a satisfactory result following hallux valgus correction.

Introduction/Purpose: Current literature shows similar clinical outcomes between first metatarsophalangeal joint arthrodesis and polyvinyl alcohol hydrogel (synthetic cartilage implant or SCI) hemiarthroplasty in the treatment of hallux rigidus; however, prior studies have not reported validated patient-reported outcome measures. To our knowledge, this is the first study to compare patient-reported outcome measures using the validated Patient Reported Outcomes Measurement Information System (PROMIS) in patients treated for hallux rigidus with metatarsophalangeal joint arthrodesis and SCI hemiarthroplasty. In addition, this novel study provides comparative data of the complication and revision rates for each procedure. Methods: A retrospective review of prospectively collected data within an institutional registry identified 101 patients who underwent metatarsophalangeal joint arthrodesis and 82 patients who underwent SCI hemiarthroplasty for treatment of hallux rigidus between January 2016 and June 2022. Chart review was performed to obtain demographic information, complications, and revision rates. Preoperative, 1-year, and 2-year PROMIS scores were obtained from the registry and confirmed via chart review. Equivalence testing was performed using two one sided t-tests (TOST) and setting a +/-5 unit margin of difference as the clinically meaningful difference to determine if there was a difference in PROMIS scores between groups. Linear regression models were also utilized to compare adjusted postoperative PROMIS scores between the two cohorts. For the equivalence testing, a p-value > 0.05 indicated a statistically significant result. Results: Demographic information and preoperative hallux rigidus severity between the cohorts showed no statistically significant difference (Table 1). The SCI cohort had no intra-operative or post-operative wound complications, but one patient within the MTP fusion cohort was treated for a superficial wound infection. The SCI group had six patients revised to MTP fusions within 3- years due to continued pain and/or implant subsidence. The MTP fusion group had 2 patients revised due to non-union and 13 patients that had symptomatic hardware requiring removal. Equivalence comparison of PROMIS scores showed the SCI cohort had significantly worse pain intensity scores at 2 years and significantly less improvement in pain intensity scores from pre- operative to 1-year post-op (Table 2). There were no differences found between cohorts for other PROMIS domains. Conclusion: For the treatment of hallux rigidus, the SCI hemiarthroplasty and metatarsophalangeal joint arthrodesis have equivalent outcomes for all PROMIS domains except the pain intensity domain. While patients in both cohorts had improvement in pain from pre-operative to post-operative time points, SCI was not as effective as first MTP fusion at relieving pain intensity at a follow-up of 2 years. While SCI is a motion-sparing procedure, patients with a primary goal of improving pain may be better suited for first MTP joint arthrodesis. Tables demonstrating the comparisons of both the preoperative demographic data as well as demonstrating the PROMIS scores across different time periods (preoperative, 1 year and 2 years).

Introduction/Purpose: Physical activity and returning to sports are vital for athletes after foot and ankle surgery. While joint preservation is preferred, joint arthrodesis becomes necessary in certain injuries or deformities. Common procedures include Lisfranc arthrodesis, modified Lapidus for hallux valgus (HV), and first metatarsophalangeal (MTP) arthrodesis for hallux rigidus (HR), addressing pain and deformities. Prior studies show promising outcomes individually, yet lack comparisons, impeding understanding of postoperative differences in function. Comparative insights can guide patient expectations and shared decisions pre-surgery. Thus, this retrospective study aims to compare clinical outcomes and return to sports in the three procedure groups. Methods: Between 2006 and 2014, a study assessed 48 modified Lapidus procedures for HV (average age 37.3 years, average follow-up 2.8 years, 95.8% female), 38 Lisfranc injuries (average age 31.8 years, average follow-up 5.2 years, 47.4% female), and 50 MTP fusion for HR cases (average age 54.9 years, average follow-up 5.1 years, 66% female). The assessment focused on physical activity and return to sport, utilizing sports-specific, patient-administered questionnaires. Clinical outcomes were evaluated through the Foot and Ankle Outcome Score (FAOS), encompassing pain, symptoms, stiffness, daily function, sports function, and quality of life. Comparison among the surgical groups included return-to-activity difficulty, participation levels, postoperative FAOS scores, and patient satisfaction. ANOVA analysis gauged significance in FAOS subscale differences among procedures, followed by the Tukey HSD test to pinpoint specific procedure variations if significant differences arose. Results: Regarding FAOS scores, the procedures yielded similar outcomes in the pain subscale. No differences between Lapidus- Lisfranc in the symptom subscale (P=0.6). However, MTP fusion displayed poorer scores than Lapidus (P=0.04) and Lisfranc (P=0.005). No differences between Lapidus-Lisfranc (P=0.64) and Lapidus-MTP Fusion in Activities of Daily Living (P=0.18). Yet, MTP fusion exhibited notably worse outcomes than Lisfranc (P=0.03). For Sports, no differences between Lapidus-Lisfranc (P=0.94), while MTP fusion showed inferior outcomes to Lapidus (P=0.002) and Lisfranc (P=0.001). Although means varied, no differences were observed for Lapidus vs. Lisfranc (P=0.95), Lapidus vs. MTP Fusion (P=0.09), or Lisfranc vs. MTP fusion (P=0.06) in Quality of Life [Table 1]. Collectively, patients engaged in 40 activities. Return to sport post-surgery percentage, compared among procedure groups, yielded similar outcomes [Table 2]. Conclusion: Although all procedure groups had similar overall return to sports and physical activities patient satisfaction rates, there were significant differences in regard to FAOS scores. Lapidus and Lisfranc procedures displayed similar postoperative outcomes in all FAOS domains. MTP Fusion showed similar postoperative outcomes to both Lapidus and Lisfranc procedures in the FAOS pain and quality of life domains, however displayed significantly worse outcomes in symptoms, activities of daily living, and sports domains. Therefore, it appears that an MTP fusion results in more functional limitations when compared to Lapidus and Lisfranc procedures. Table 1: Comparison of FAOS Scores in Patients who Underwent Lapidus, Lisfranc, and MTP Fusion Procedures; Table 2: Postoperative Changes in Activity Difficulty and Participation Levels