Preoperative PROMIS Physical Function Scores Predict Postoperative Outcomes Following Total Ankle Replacement

Area of Science:

• Orthopedic Surgery
• Patient-Reported Outcomes
• Predictive Analytics in Medicine

Background:

• Total ankle replacement (TAR) offers significant benefits for end-stage ankle arthritis, but a subset of patients experience limited improvement.
• Identifying predictors of surgical success is crucial for optimizing patient selection and managing expectations.

Purpose of the Study:

• To investigate the predictive value of preoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores for identifying patients likely to achieve meaningful improvement after TAR.
• To assess the utility of PROMIS physical function, pain interference, pain intensity, and depression scores in predicting postoperative outcomes.

Main Methods:

• Analysis of prospectively collected preoperative and postoperative PROMIS scores (physical function, pain interference, pain intensity, depression) from 111 feet in 105 patients.
• Definition of significant postoperative improvement based on minimal clinically important differences (MCIDs).
• Application of logistic regression and area under the curve (AUC) analyses to evaluate predictive accuracy.

Main Results:

• Statistically significant AUCs were observed for preoperative PROMIS physical function (AUC = 0.728, P = .004), pain intensity (AUC = 0.720, P = .018), and depression (AUC = 0.761, P < .001).
• The PROMIS pain interference domain did not yield a statistically significant AUC, indicating limited predictive value.

Conclusions:

• Preoperative PROMIS physical function and pain intensity scores can predict postoperative improvement in patients undergoing fixed-bearing TAR.
• PROMIS pain interference scores were not found to be reliable predictors of outcomes following TAR.
• These findings can inform future research on patient-reported outcomes in TAR and guide clinical decision-making.