Patients’ views of ankle replacement and ankle fusion surgery v1.0
Research type
Research Study
Full title
Perceptions of surgery, education, rehabilitation and outcomes among patients who have undergone total ankle replacement or ankle arthrodesis: a qualitative study
IRAS ID
252577
Contact name
Anne-Maree Keenan
Contact email
Sponsor organisation
University of Leeds
Duration of Study in the UK
0 years, 4 months, 20 days
Research summary
Research Summary
What are the views of patients who have had an ankle replacement or ankle fusion about these operations?
Ankle arthritis is a relatively common condition involving wear and tear of the ankle joint. Patients with ankle arthritis may have a lot of pain and find daily activities difficult. If these problems are particularly bad, patients may need surgery. Patients who need surgery for ankle arthritis usually have one of the following operations:
• Ankle replacement- this involves replacing the damaged joint with an artificial joint.
• Ankle fusion- this involves screwing the bones of the ankle joint together.Approximately 3,000 patients have an ankle replacement or ankle fusion each year in the UK. At present, we do not have a good understanding of which of these operations is best for patients or what patients’ views about these operations are. Also, the UK does not have agreed guidelines about what education and exercise advice should be provided to patients having these operations.
The purpose of this study is to understand patients’ views of ankle replacement and ankle fusion surgery. We plan to include eight patients who have had an ankle replacement or ankle fusion. We will ask each participant to discuss their views of ankle replacement and ankle fusion surgery during a one-off interview. The questions will focus on finding out what participants think about their operation and the education and exercise advice provided. Participants will be recruited from Chapel Allerton Hospital, Leeds. Participants will be able to choose whether they would like the interview to take place at Chapel Allerton Hospital or their own home.
We will use the study findings to:
• Improve the education and exercise advice provided to patients having ankle replacement or ankle fusion surgery in the future.
• Guide further research.Summary of Results
Background and aim Ankle arthritis is a fairly common condition which can cause a lot of pain and other symptoms like stiffness. This can make it hard for people to carry out normal daily activities. Most people with ankle arthritis can manage their symptoms using treatments like exercise and painkillers. But some peoples’ symptoms have a very big impact on their lives. These people may be offered one of the following operations to help relieve their symptoms.
- Ankle replacement: this involves replacing the damaged joint with an artificial joint.
- Ankle fusion: this involves screwing the bones of the ankle joint together.Estimates suggest over 3,000 patients have an ankle replacement or ankle fusion each year in the UK. At present, we do not have a good understanding of which of these operations is best for patients. In addition, no previous studies have explored patients’ views of ankle replacement and fusion surgery across the full care pathway from when they first sought help for their ankle arthritis through to when they had recovered from their operation. Our study aimed to help address this by exploring patients’ views of ankle replacement and ankle fusion surgery.
What did we do?
We interviewed seven patients who had undergone ankle replacement and/or ankle fusion surgery. To make sure we heard a range of views, we interviewed patients who varied in their gender, the type of operation they had undergone, and how long ago their operation was. Each patient took part in a single face-to-face interview.
During each interview, we asked the patient to talk about their experiences of having ankle replacement or fusion surgery. This included talking about why they had decided to have surgery, what they thought of the care they received, and how pleased they were with their recovery. We recorded and reviewed all the interviews to identify patterns in what the patients said. We organised the findings into summaries called ‘themes’. We split each theme into smaller summaries called ‘subthemes’.What did we find?
We developed three themes based on the interview findings. Each theme was made up of two subthemes as follows.Theme 1: Decision making
This theme explains why the participants decided to seek help for their ankle arthritis and how they decided between ankle replacement and fusion surgery. Its subthemes were decision to seek help and decision between surgical options.
The participants sought help when their ankle pain affected their ability to carry out valued activities like sleeping and walking. Other factors also influenced their decision making. For example, some participants sought help because they thought their ankle condition would get worse without surgery.
Many factors affected the participants’ decision making about which type of operation to have. These included their surgeon’s advice/opinion, their views of ankle replacement and fusion surgery and their personal circumstances. For example, some participants thought having an ankle fusion would cause them to limp, so wanted to have an ankle replacement instead.Theme 2: Perceptions of support
This theme covers the participants’ views of information, education and the clinical support they received from their care team. Its subthemes were perceptions of information and education, and perceptions of clinical support.
Participants looked for and/or received information from their surgeon, other patients and the Internet. Most participants felt that they did not receive enough information on topics like what to expect before and after their operation.
Although most participants were happy with their surgery, some had negative views of parts of their clinical support. For example, a couple of participants felt forgotten when they were transferred between surgeons. In addition, some participants felt they were discharged from hospital too soon.Theme 3: Impact on the individual
This theme highlights how the participants’ personal circumstances and beliefs affected their recovery and describes their overall views of their recovery. Its subthemes were influence of individual circumstances and beliefs, and post-operative outcomes.
A range of personal circumstances appeared to have an impact on how the participants recovered. For example, some participants had other health problems that affected their recovery and most participants felt that self-motivation is key to recovering.
Participants reported having problems such as pain and swelling in the early part of their recovery. In the longer term, most participants were pleased with their recovery. However, a couple of participants still had problems like pain and difficulty walking.Next steps
We hope that the findings of this study will be used to help:
- improve the education and support provided to patients having an ankle replacement or ankle fusion;
- guide future research.Considerations for future research
Many factors can affect patients’ decision-making about ankle replacement and fusion surgery and their views of their care and recovery. Some factors identified in this study were common to all participants. Other factors were linked to their personal circumstances and beliefs.
The education and clinical support participants received had a big impact on their experiences. But most participants felt that their education and support needs were not fully met.
The findings highlight the importance of providing patients undergoing ankle replacement or fusion surgery with appropriate education and clinical support, tailored to their personal needs.Acknowledgements and funding
We would like to thank all the participants for sharing their valuable insights. This summary presents independent research funded by the North East of England and Yorkshire and Humber Council for Allied Health Professions Research (CAHPR) Hubs and National Institute for Health and Care Research (NIHR) Devices for Dignity and supported by the NIHR Leeds Biomedical Research Centre (BRC). Professor Claire Brockett was supported by an EPSRC Discipline Hopping Grant (EP/S023119/1). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
18/NW/0819
Date of REC Opinion
13 Dec 2018
REC opinion
Favourable Opinion