The impact of pre-operative mental health on outcomes of foot and ankle surgery: A scoping review.

BACKGROUND: Evidence suggests that certain groups of orthopaedic patients have an increased prevalence of mental health disorders than the general population. This scoping review aims to evaluate the effect of pre-operative mental health on outcomes of foot and ankle surgery. METHODS: A literature search was performed in four databases. Studies investigating a relationship between preoperative mental health and postoperative patient reported outcome measures (PROMs), complications, readmissions or reoperations were included. RESULTS: Of the 19 studies investigating the effect of preoperative mental health on PROMs, 16 (84.2%) reported a significant relationship between poorer preoperative mental health and inferior postoperative PROMs. Poorer mental health was associated with an increased rate of complications, readmissions and/or reoperations in four studies. CONCLUSIONS: Poorer preoperative mental health is associated with significantly inferior outcomes following foot and ankle surgery. Clinicians should evaluate mental health to stratify likely outcomes and aid in the management of patient expectations. LEVEL OF EVIDENCE: Level IV: Scoping review of Level II-IV studies.

Learning curve of total ankle arthroplasty: a systematic review.

INTRODUCTION: Together with ankle arthrodesis, total ankle arthroplasty is now accepted as a first-line intervention in the management of end-stage arthritis of the ankle. The evidence regarding how outcomes are affected by surgeon experience is inconsistent; we performed a systematic review to evaluate the effect of a learning curve in total ankle arthroplasty outcomes. METHODS: An electronic database search was performed in PubMed, Embase, ISI Web of Science and Cochrane trials. Two reviewers independently conducted a two-stage title/abstract and full text screening. English-language original research studies comparing patient-reported outcome measures (PROMs), complication/revision rates, operative time, length of stay or radiation exposure according to surgeon experience were included. Quality assessment was performed using the methodological index for non-randomised studies. RESULTS: All but one included study report either improved PROMs, reduced complication/revision rate, reduced hospital stay length/operative time or reduced radiation exposure with increasing surgeon experience. However, the majority of these findings lack statistical significance. Two studies assessing the plateau of the learning curve report a wide range of plateau thresholds between 9 and 39 cases. CONCLUSION: This review finds a largely non-significant trend towards improvements in PROMs, complication, and revision rates with improved surgeon experience. The lack of statistical significance in a number of studies may be partially explained by methodological flaws, with more suitably designed studies reporting significant improvements. Future research into the effect of advancements in implant design and insertion guides is required to further characterise the magnitude of the learning curve and guide both mitigation and learning strategies.

Delayed Presentation of Non-traumatic Bilateral Leg Pseudoaneurysms Mimicking Soft-Tissue Sarcoma - A Case Report.

Introduction: Non-traumatic pseudoaneurysms are very rare but should be considered as a differential diagnosis on patients presenting with a thigh mass. Case Report: We present an extremely unusual case of a 70-year-old patient who presented with clinical features of a soft-tissue sarcoma of the thigh that instead was proven to be a non-traumatic pseudoaneurysm. There was also incidental finding of bilateral leg non-traumatic pseudoaneurysms. Conclusion: Medical practitioners must consider the possibility of non-traumatic pseudoaneurysm in patients that present with a thigh mass.