Patient Characteristics of Possible Responders and Nonresponders to Total Ankle Arthroplasty

Abstract

Background: Characteristics of responders, or those who achieve a clinical improvement above the level of a minimal clinically important difference, have not been defined for total ankle arthroplasty (TAA). The purpose of this study was to determine patient characteristics that distinguish possible responders from possible nonresponders after TAA using criteria established for other arthroplasty surgeries. Methods: Patients undergoing TAA who were enrolled into a prospective study at a single academic center evaluating patient-reported outcomes were included. Patients were characterized as possible responders if the relative or absolute improvement in their 2-year follow-up Short Musculoskeletal Function Assessment (SMFA) function score was at least 50% or 20, respectively, compared with their preoperative score, consistent with Outcome Measures in Rheumatoid Arthritis Clinical Trials and the Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. Patient factors were then associated with possible responder or nonresponder status and a multivariable analysis was performed. A total of 491 patients with complete data and 2-year follow-up were included in this study. Results: Multivariable analysis demonstrated that a higher baseline 36-Item Short-Form Survey (SF-36) mental component summary (MCS) score (OR [95% CI], 1.02 [1.01, 1.04]; P = .003), indicating better mental health, was associated with being a possible responder to TAA. The presence of rheumatic disease (OR [95% CI], 0.38 [0.22, 0.67]; P = .001) was a significant predictor of being a possible nonresponder. Conclusion: Our data reveal that a higher baseline SF-36 MCS score was associated with increased improvement in SMFA function scores, while rheumatic disease was associated with worse improvement in SMFA function scores after TAA. Patients with rheumatic disease or poor mental health may not achieve as favorable results after TAA and should be counseled appropriately. Level of Evidence: Level III, retrospective comparative study.

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

“…Factors such as ipsilateral hindfoot fusion, rheumatoid disease, poor mental health, and peripheral vascular disease have been associated with poor outcomes following TAR. 3,6,23,24 Previous studies have demonstrated that patient-reported outcome measures (PROMs) may be useful in predicting who will achieve meaningful improvement after operative intervention for a variety of foot and ankle disorders. 2,11,18,25 PROMs may be employed preoperatively to evaluate the severity of patients' symptoms and counsel patients about the expected benefit of surgery.…”

“…Factors such as ipsilateral hindfoot fusion, rheumatoid disease, poor mental health, and peripheral vascular disease have been associated with poor outcomes following TAR. 3,6,23,24…”

Does Mental Health impact the outcomes of Total Ankle Arthroplasty? A Systematic Review

“…All the necessary data were retrieved from the studies that ascertained the correlation between mental health disorders and postoperative outcomes and complications. Three of the included studies were prospective studies [22][23][24] and the other four were retrospective studies [25][26][27][28] . The level of evidence (II and III) was reported for the included studies.…”

“…Mental health conditions included within the articles were depression [22][23][24][25][26][27][28] , schizophrenia 28 , bipolar disorder 28 and overall mental health 27 . The prevalence of depression ranged from 11.4-32.5% [22][23][24][25] (Table 2).…”

Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis

“…As a result, 9 studies with a total of 10 388 patients were eligible for inclusion in the quantitative analysis [6][7][8]15,16,26,53,62,64 and 28 in the narrative synthesis. [1][2][3][4][5][9][10][11]13,14,[17][18][19]23,25,29,[34][35][36]40,44,47,48,50,51,56,59,65…”