The Impact of Preoperative Mental Health and Depression on Outcomes After Total Ankle Arthroplasty

Abstract

Background: Preoperative mental health and depression have been shown to negatively impact patient-reported outcome measures after a broad array of orthopaedic procedures including total ankle arthroplasty. The hypothesis for this study was that decreased Short Form (SF)-36 Mental Component Summary (MCS) scores will modulate the impact of depression on patient-reported outcome measures after total ankle arthroplasty. Methods: All patients undergoing primary total ankle arthroplasty between January 2007 and December 2016 who were enrolled into a prospective outcomes study and who had at least 1-year minimum study follow-up were retrospectively reviewed. Patients were separated into 4 groups based on the presence or absence of an SF-36 MCS score of <35 points and diagnosis of depression. SF-36 Physical Component Summary (PCS) and MCS scores, Short Musculoskeletal Function Assessment (SMFA) function and bother components, and visual analog scale (VAS) pain were collected preoperatively and in the 1 to 2-year follow-up. The Wilcoxon rank sum was used to assess differences in outcomes by depression and low preoperative MCS scores. Multivariable models were then constructed to evaluate between-group differences in change scores according to preoperative SF-36 MCS scores and a diagnosis of depression, with adjustment for baseline patient and treatment characteristics. Results: Patients with depression and those with low preoperative MCS scores had significantly worse final outcome scores along with reduced improvement in SF-36 PCS and VAS pain scores compared with patients without these risk factors. Among patients with depression, low preoperative MCS scores helped to differentiate patients with poor final outcome scores. Similarly, in patients with low preoperative MCS scores, depression helped to differentiate patients with poor final outcome scores. Conclusions: Although patients achieved significant improvements in functional outcomes regardless of cohort, decreased preoperative mental health modulated the impact of depression on outcomes. Patients with diminished preoperative mental health and depression are at an increased risk for sustaining smaller improvements in outcomes. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Impact of Psychological Health on Patient Recovery After Arthroplasty

“…Our study shows that the scores of the postoperative evaluation indices were influenced by the patients’ psychological health states ( Table 4 ). From our analysis, we found that a poor psychological state was negatively related to early postoperative recovery, which is in line with published studies ( 8 , 9 , 12 , 43 ). Anxiety and depression symptoms led to lower satisfaction rates of patients at 6 months postoperatively ( Table 5 ).…”

“…Psychological disorders can negatively impact the way that a person feels, acts, and thinks; therefore, psychological disorders may negatively influence patient satisfaction and functional outcomes related to treatment. Some studies (8)(9)(10)(11)(12) have demonstrated that psychological state influences TJA outcomes, whereas other studies (13)(14)(15)(16) have found no significant correlation between preoperative mental health status and postoperative physical function. Therefore, whether a psychological state can affect postoperative recovery is controversial.…”

“…Some studies ( 8 – 12 ) have demonstrated that psychological state influences TJA outcomes, whereas other studies ( 13 – 16 ) have found no significant correlation between preoperative mental health status and postoperative physical function. Therefore, whether a psychological state can affect postoperative recovery is controversial.…”

Depression Following Operative Treatments for Achilles Ruptures and Ankle Fractures

“…3 Depressed mood has been shown to negatively impact outcomes for many orthopaedic procedures, including total ankle arthroplasty. 4,5,15 The most extreme consequence of MDD is suicide, and suicide prevention is at the heart of mental health intervention. 9 For patients with acute ankle injuries undergoing surgery, orthopaedic surgeons might consider (1) screening postoperative patients with PHQ-9 assessments and referring those with elevated scores to mental health services, (2) providing information about mental health services to all patients, or (3) providing information about mental health services to patients with the factors shown here to increase risk.…”

Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study

“…11 Most cases of tibiotalar OA are secondary to trauma, 40 and patients are typically younger than those with knee OA. 32 Tibiotalar fusion 1 and total ankle replacement (TAR) 3,4,10,13,18,37,38,41,50 are currently the only effective treatments for end-stage tibiotalar OA. Ankle replacement is an attractive alternative to fusion because it allows for tibiotalar motion.…”