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

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.

"I Don't Have to Think About Watching the Ground": A Qualitative Study Exploring the Concept of Vigilance as an Important Outcome for Ankle Reconstruction.

OBJECTIVE: To understand patients' experiences of ankle reconstruction for treatment of end-stage ankle osteoarthritis. METHODS: Individuals were recruited from a cohort of individuals who had undergone total ankle replacement or ankle fusion. English-speaking individuals who had surgery at least 1 year prior were invited to participate. Semistructured, face-to-face interviews relying on a phenomenological approach were conducted in a private hospital clinic room. RESULTS: A total of 25 adults (12 women, 13 men), ages 25-82 years, were interviewed for 1-2 hours. Participants commonly described a state of having to keep careful watch for potential environmental challenges. Vigilance was related to ongoing symptoms (i.e., pain, stiffness) and concerns regarding balance, stability, and potential damage to the fused ankle or implant. Vigilance was described along a continuum, with higher levels associated with stress and mental exhaustion. Vigilance affected participants' perception of their surgical outcome, with high vigilance levels linked to negative perceptions of outcome. The degree to which individuals perceived the need for vigilance was influenced by environmental factors like uneven ground or crowds. Contrary to descriptions of vigilance in the coping literature, vigilance related to ankle reconstruction constituted a situational, rather than dispositional, response. CONCLUSION: Vigilance and its associated burden are not captured by current instruments. The mental load and worry associated with vigilance was important to patients, distinct from related pain or functional status. Thus, reducing high levels of vigilance appears to be an appropriate target for patient-centered treatment outcomes. A thorough battery of outcome measures for ankle reconstruction should consider this domain.

Functional disabilities and issues of concern for Asian patients before total ankle arthroplasty.

Total ankle arthroplasty is a commonly performed invasive procedure that can be distressing to patients. Therefore, surgeons should consider patients' issues of greatest interest and concerns at the time of surgery and the function that patients hope to recover. Many studies have reported surgeon concerns before total knee arthroplasty and total hip arthroplasty, but few have focused on patients. The purpose of this study was to evaluate patients' functional disabilities and issues of concern regarding total ankle arthroplasty.Between May 2008 and June 2010, eighty-five patients (52 men and 33 women; mean age, 60 years) were recruited for the study. All patients were asked to complete a questionnaire divided into 3 parts: sociodemographic data, current functional disabilities and their perceived importance, and issues concerning patients before total ankle arthroplasty. Regarding functional disability based on severity, the top 5 issues were limping, difficulty squatting, daytime pain, difficulty kneeling, and difficulty climbing stairs. Regarding functional disability based on perceived importance, the top 5 issues were daytime pain, limping, difficulty walking, difficulty kneeling, and difficulty working. Regarding issues of concern, the top 5 issues were pain intraoperatively, ability to walk as much as desired, ability to climb stairs, pain after discharge from the hospital, and pain immediately postoperatively. The most important issue before total ankle arthroplasty was pain. Patients had a strong interest in high ankle extension and increased range of motion due to the lifestyle and religious activities of Eastern populations.