Alumise hüppeliigese ehk subtalaarliigese artroskoopiliselt assisteeritud artrodees

Alumise hüppeliigese ehk subtalaarliigese osteoartoos on suhteliselt harva esinev probleem, kuid see mõjutab patsiendi elukvaliteeti oluliselt. Subtalaarliigese osteoartroosist põhjustatud probleeme ravitakse nii konservatiivsete kui ka operatiivsete meetoditega. Sageli on kirurgiline ravilahendus ainuvõimalik hea või väga hea lõpptulemuse saavutamiseks. Lahtine operatsioon on osteoartroosiga patsientidel alumise hüppeliigese artrodeesi valikmeetod olnud aastakümneid. Miniinvasiivse kirurgia kiire arengu käigus on leitud, et artroskoopiliselt assisteeritud subtalaarliigese artrodees on kujunemas tõhusaks valikmeetodiks subtalaarliigese artroosi ravis. Tartu Ülikooli Kliinikumis on aastatel 2016–2017 ravitud artroskoopiliselt assisteeritud artrodeesiga kokku 4 subtalaarliigese osteoartroosiga patsienti. Kõikides opereeritud liigestes toimus radioloogilise uuringu alusel luustumine 8–10 nädala jooksul. Kirurgilise raviga seotud tüsistusi ei esinenud. Kõik patsiendid pöördusid tagasi aktiivse füüsilise tegevuse juurde. Tuginedes positiivsetele tulemustele mujal maailmas, võime ka meie väikese rühma puhul kinnitada selle metoodika efektiivsust

Structural validity of the Finnish Manchester-Oxford Foot Questionnaire (MOXFQ) using the Rasch model

Background: The 16-item patient-reported Manchester-Oxford Foot Questionnaire (MOXFQ) with subscales of pain, social interactions, and walking/standing has been claimed for strongest scientific evidence in measuring foot and ankle complaints. This study tests the validity of the Finnish MOXFQ for orthopaedic foot and ankle population using the Rasch analysis. Methods: We translated the MOXFQ into Finnish and used that translation in our study. MOXFQ scores were obtained from 183 patients. Response category distribution, item fit, coverage, targeting, item dependency, ability to measure latent trait (unidimensionality), internal consistency (Cronbach's alpha), and person separation index (PSI) were analyzed. Results: Fifteen of the items had ordered response categories and/or sufficient fit statistics. The subscales provided coverage and targeting. Some residual correlation was noted. Removing one item in the pain subscale led to a unidimensional structure. Alphas and PSIs ranged between 0.68-0.90 and 0.67-0.92, respectively. Conclusions: Despite some infractions of the Rasch model, the instrument functioned well. The subscales of the MOXFQ are meaningful for assessing patient-reported complaints and outcomes in orthopaedic foot and ankle population. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

Background: Patient-reported outcomes (PROS) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments. Methods: Altogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester-Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed. Results: Based on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument. Conclusions: The ePRO versions of the FAAM, the FAOS, the MOXFQ and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.Peer reviewe

The Effects of goal involvement on moral behavior in an experimentally manipulated competitive setting

Ravi toopilise negatiivse rõhuga ehk vaakumravi on maailmas populaarsust koguv ravimeetod, millega on saadud häid tulemusi mitmesuguste haavade ravis. Arvukad artiklid on sedavõrd heterogeensed, et põhjapanevaid järeldusi on raske teha. Artikli eesmärgiks on anda kirjanduse põhjal ülevaade vaakumravi olemusest ja selle kasutamise võimalustest ning võtta kokku vaakumravi tulemused TÜ Kliinikumis aastatel 2007–2009. Retrospektiivselt analüüsitud 55-st vaakumravi saanud patsiendist oli ravi edukas 87%-l juhtudest. Parimad ravitulemused saadi krooniliste haavade puhul. Vaakumravi võib olla haavade ravis edukas meetod, kuid selle efektiivsuse paremaks hindamiseks ning näidustuste optimeerimiseks oleks vaja korraldada prospektiivseid uuringuid. Eesti Arst 2010; 89(12):809−81

Minimal Important Change for the Visual Analogue Scale Foot and Ankle (VAS-FA)

Background Visual analogue scale foot and ankle (VAS-FA) is a patient-reported outcome measure for foot and ankle disorders. The VAS-FA is validated into several languages and well adopted into use. Nonetheless, minimal important change (MIC) for the VAS-FA has not been estimated thus far. Methods The VAS-FA score was obtained from 106 patients undergoing surgery for various foot and ankle complaints. MIC was estimated using an anchor-based predictive method. Results The adjusted MIC was 6.8 for total VAS-FA score, and 9.3 for the Pain, 5.8 for the Function, and 5.7 for the Other complaints subscales. The VAS-FA score was found to separate improvement and deterioration in patients’ foot and ankle condition. Conclusions MIC was successfully defined for the VAS-FA in the current study. The VAS-FA can be used to evaluate foot and ankle patients’ clinical foot and ankle status and its change. Further research on estimating disease-specific MICs is recommended.Peer reviewe

Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,701 patients

BACKGROUND AND PURPOSE: Post-traumatic knee osteoarthritis following proximal tibia fracture (PTF) is a common complication that may lead to total knee replacement as secondary treatment (TKRS). We determined the risk of TKRS following PTF, whether treated nonoperatively or operatively, and compared the results with a 38-fold control group without prior PTF. PATIENTS AND METHODS: We identified all patients over 18 years of age in Finland with PTF treated during the period 2009–2018 from the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). Age, sex, treatment method, follow-up time, and possible TKRS were recorded. RESULTS: 7,701 patients were treated for PTF during the period 2009–2018. Over the 5.1-year (SD 3.1) follow-up, TKRS was performed in 340 (4.3%) patients with a prior PTF after a mean of 2.1 (SD 2.0) years post-fracture. TKRS was needed in 138 (3.7%, HR 1.8) patients in the nonoperatively treated group and in 202 (5.0%, HR 3.2) patients in the operatively treated group. Operative treatment, female sex, and high age were identified as risk factors for TKRS. The incidence of TKRS was highest during the first 2 years after fracture and remained elevated throughout the follow-up. INTERPRETATION: Patients with a prior PTF had a 1.8- to 3.2-fold higher risk of TKRS compared with controls during the first 5 years post-fracture. Risk of TKRS was associated with an operatively treated PTF, female sex, and high age. The patients in the operative group likely sustained more complex fractures, while female sex and age may be explained by more osteoporotic bone quality