EFAS Score - Validation of Danish Version by the Score Committee of the European Foot and Ankle Society (EFAS).

BACKGROUND: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in 13 languages. Currently, the Danish version completed data acquisition and underwent further validation. METHODS: The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory. RESULTS: The internal consistency was confirmed in the Danish version (Cronbach's Alpha 0.88). The Standard Error of Measurement (SEM) was 0.31 and is similar to other language versions. Between baseline and follow-up, 77.2% of patients showed an improvement on their EFAS score, with adequate responsiveness (effect size 1.05). CONCLUSIONS: The Danish EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.

EFAS Score-Validation of Spanish and Estonian Versions by the Score Committee of the European Foot and Ankle Society (EFAS).

BACKGROUND: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in 11 languages (Dutch, English, German, Finnish, French, Italian, Polish, Portuguese, Persian, Swedish, Turkish). From other languages under validation, the Spanish and Estonian versions completed data acquisition and underwent further validation. METHODS: The EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during the initial validation study), 2) item reduction and scale exploration (completed during the initial validation study), 3) confirmatory analyses and responsiveness of the Spanish and Estonian versions (completed during the initial validation study in seven other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory. RESULTS: The internal consistency of the scale was confirmed in the Spanish and Estonian versions (Cronbach's Alpha>0.8). Responsiveness was good, with moderate to large effect sizes in both languages, and evidence of a statistically significant positive association between the EFAS Score and patient-reported improvement. CONCLUSIONS: The Spanish and Estonian EFAS Score versions were successfully validated in orthopaedic ankle and foot surgery patients, with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.

EFAS Score - Validation of Portuguese Version by the Score Committee of the European Foot and Ankle Society (EFAS).

BACKGROUND: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in ten languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish, Portuguese). From other languages under validation, the Portuguese version completed data acquisition and underwent further validation. METHODS: The Portuguese version of the EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Portuguese version (completed during initial validation study in nine other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory. RESULTS: The internal consistency was confirmed in the Portuguese version (Cronbach's Alpha 0.84). The Standard Error of Measurement (SEM) was 0.27 and is similar to other language versions. Between baseline and follow-up, 69.4% of patients showed an improvement on their EFAS score, with adequate responsiveness (effect size 0.64). CONCLUSIONS: The Portuguese EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.

EFAS Score -Validation of Persian Version by the Score Committee of the European Foot and Ankle Society (EFAS).

BACKGROUND: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in nine European languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish). From other languages under validation, the Persian version finished data acquisition and underwent further validation. METHODS: The Persian version of the EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Persian version (completed during initial validation study in nine other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory. RESULTS: The internal consistency was confirmed in the Persian version (Cronbach's Alpha 0.82). The Standard Error of Measurement (SEM) was 0.38 and is similar to other language versions. Between baseline and follow-up, 97% of patients showed an improvement on their EFAS score, with excellent responsiveness (effect size 1.93). CONCLUSIONS: The Persian EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.

EFAS Score - validation of Finnish and Turkish versions by the Score Committee of the European Foot and Ankle Society (EFAS).

BACKGROUND: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in seven European languages (English, German, French, Italian, Polish, Dutch, Swedish). From other languages under validation, the Finnish and Turkish versions finished data acquisition and underwent further validation. METHODS: The EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Finnish and Turkish version (completed during initial validation study in seven other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory. RESULTS: The internal consistency of the scale was confirmed in the Finnish and Turkish versions (Cronbach's Alpha >0.8). Responsiveness was good, with moderate to large effect sizes in both languages, and evidence of a statistically significant positive association between the EFAS Score and patient-reported improvement. CONCLUSIONS: The Finnish and Turkish EFAS Score versions were successfully validated in the orthopaedic ankle and foot surgery patients, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.

EFAS Score - Multilingual development and validation of a patient-reported outcome measure (PROM) by the score committee of the European Foot and Ankle Society (EFAS).

BACKGROUND: A scientifically sound validated foot and ankle specific score validated ab initio for different languages is missing. The aim of a project of the European Foot and Ankle Society (EFAS) was to develop, validate, and publish a new score(the EFAS-Score) for different European languages. METHODS: The EFAS Score was developed and validated in three stages: (1) item (question) identification, (2) item reduction and scale exploration, (3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre-operatively and at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory. RESULTS: Stage 1 resulted in 31 general and 7 sports related questions. In stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach's Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed. CONCLUSIONS: The multi-language EFAS Score was successfully validated in the orthopaedic ankle and foot surgery patient population, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.

The Rotoglide™ total replacement of the first metatarso-phalangeal joint. A prospective series with 7-15 years clinico-radiological follow-up with survival analysis.

BACKGROUND: The Rotoglide total replacement of the MTP-1 joint. 15 years survival analysis. The purpose of this prospective study was to evaluate the long-term performance clinico-radiographically of an uncemented three-component total replacement for the first metatarso-phalangeal joint (MTP-1) used for hallux rigidus (primary osteoarthritis grades 3 and 4). The follow-up was median 11.5 years (7-15). METHODS: The AOFAS forefoot score was used preoperatively and at follow-up. Radiographs were taken weight-bearing in the AP-projection and in tip-toe standing in the lateral view. Arthrosis in the sesamoid junction, prosthetic loosening, subsidence (of prosthesis as well as sesamoids), and dorsiflexion were measured, recorded and subjected to multiple variance analysis. Survival analysis was performed for 15 years. MATERIAL: Ninety implants in 80 patients (53 women and 27 men); median age 58 (41-76) were evaluated. RESULTS: Six patients representing seven prostheses in situ had died from unrelated reason. The median preoperative AOFAS increased significantly from 40 to 95. The median gain was 45. Four replacements (4.4%) were extracted for other reasons than loosening. No aseptic loosenings were recorded. The survival rate at 15 years was 91.5% (83-100). Multiple variance analysis showed that arthrosis in the metatarso-sesamoid junction correlated with reduced AOFAS score. CONCLUSION: The prosthesis has stood the test of time; the results justify its further use.

Prospective analysis of a first MTP total joint replacement. Evaluation by bone mineral densitometry, pedobarography, and visual analogue score for pain.

BACKGROUND: We hypothesized that a total replacement of the first metatarsophalangeal joint (MTP-1) would alter the walking pattern with medialisation of the ground reaction force (GRF) of the foot and subsequently cause an increase in bone mineral density (BMD) in the medial metatarsal bones and a decline of BMD in the lateral metatarsal bones. METHODS: Twelve patients receiving total joint replacements (Roto-Glide(®)) of MTP-1 were enrolled in a prospective cohort. BMD and pedobarography of the heel bone and the metatarsal heads were performed preoperatively and at least 12 months postoperatively. RESULTS: BMD in the lateral metatarsals and GRF under the lateral column of the operated feet decreased significantly on the operated feet. CONCLUSIONS: Total joint replacement of MTP-1 tends to reduce GRF under the lateral column of the foot causing a corresponding decline in BMD and pedobarographic measures. Our findings support the further use of the Roto-Glide(®) prosthesis for osteoarthritis of the first metatarsophalangeal joint.

Scandinavian Total Ankle Replacement (STAR).

Fifty-eight patients with either rheumatoid arthritis or osteoarthritis were treated with meniscal-bearing ankle prostheses. The concept was to mobilize, align, and stabilize the ankle before resurfacing it. Cement was used for prostheses fixation in 33 patients (1986-1989) and 25 patients had fixation without cement (1990-1995). All patients in one prospective series were followed up yearly with radiographs and with a clinical scoring system giving a maximum of 100 points. This allowed for a patient-controlled prospective study. No patients were lost to followup. The only detectable difference in the treatment was the fixation mode. For the purpose of comparing patients with cemented and uncemented prostheses, the patients who had surgery between 1986 and 1989 were not followed up after 1997, and patients who had surgery between 1990 and 1995 were not followed up after 2002. The mean followup was 9.4 years. Failure was defined as prosthesis revision or change to arthrodesis for any reason. In the cemented group, nine of 33 patients had revision surgery or fusion. In the uncemented group, one of 25 patients had revision surgery. Survivorship analysis for 12 years based on life tables showed a 70% survival rate (confidence limit, 60.3-78.5) for the cemented group and 95.4% survival rate (confidence limit, 91.0-99.9) for the uncemented group. The average clinical scores at the latest followup were 74.2 +/- 19.3 for the cemented group and 91.9 +/- 7.4 points for the uncemented group. Therefore, unconstrained meniscal-bearing ankle prostheses should be uncemented.

Bone mineral density, gait analysis, and patient satisfaction, before and after ankle arthroplasty.

Bone mineral density (BMD) and patient satisfaction were measured and gait analysis was performed in patients treated with unilateral dual-coated ankle arthroplasty. The study comprised 14 patients (eight women and six men) measured preoperatively and at a median of 15 (range, 12-26) months after surgery. BMD was measured bilaterally in the distal tibia and in the calcaneus. A plantar pressure analysis was performed, including foot contact duration and a new index for describing the ground reaction force curve called the Valley Index (VI). The patients also evaluated their level of pain, ability to cope with daily activities, adaptation of shoes, and walking ability before surgery and at follow-up on a visual analogue scale (VAS). Bone mass significantly increased adjacent to the tibial part of the prosthesis. The patients experienced less pain and improved walking and performance in daily activities. There was also a decrease in foot contact duration as well as an increase in VI and ankle range of motion. Change in bone mass was the variable that correlated best with the patients' evaluation of the general outcome of ankle arthroplasty. Correlations among other variables are described. The study concluded that a fairly simple analysis of the ground reaction force curve, bone mass measurements, and VAS can demonstrate that ankle arthroplasty is able to normalize gait, decrease foot contact duration, increase bone mass, and reduce pain.

Radiolucency adjacent to the tibial component in total knee arthroplasty.

This study determined the accuracy of standard radiographs in observing radiolucency adjacent to the tibial component in total knee arthroplasty. A model of the proximal tibia was used. Plastic sleeves of different heights were glued under the tibial tray to imitate radiolucency. By tilting the x-ray tube 1degrees at a time, an investigation was performed to determine how many degrees it would take to cover the heights of the different plastic sleeves. In a clinical study of patients at standard follow-up, 21 knees were examined using standard radiographs. Radiographs using image intensification were then taken of the same knees to obtain radiographs with views parallel to the plane of the tibial tray. The results of the study on the phantom showed that a 1degrees deviation of the x-ray beam from the optimal position would obscure a 0.5-mm "radiolucency." This was true for radiolucencies of 2, 3, 4, and 5 mm. This was confirmed in the clinical study where < or = 4 mm of radiolucency was obscured on standard radiographs. Therefore, standard radiographs cannot be used to determine radiolucency. The 2-mm radiolucency normally associated with loosening is not clinically valid.