Influence of Depressive Symptoms on Clinical Outcomes of Total Ankle Arthroplasty

Abstract

Category:Ankle ArthritisIntroduction/Purpose:Recently, there have been many reports on the relationship between depression and clinical outcome of knee or hip arthroplasty. However, there is no study on the association between depression and total clinical outcome of total ankle arthroplasty (TAA). This study investigated the relationship between depressive symptoms and clinical outcome after TAA.Methods:Forty patients who underwent TAA for end-stage ankle arthritis from July 2014 to July 2017 and were able to follow- up at least 12 months were selected. Depressive symptoms were evaluated using Center for Epidemiologic Studies Depression Scale (CES-D) and Patient Health Questionnaire-9 (PHQ-9). The subjects were divided into Depressive group and Non-depressive group, and the preoperative and postoperative clinical results were compared using a visual analogue scale (VAS), American orthopedic foot and ankle-hindfoot score (AOFAS). The preoperative and postoperative radiological results were also compared using anterior surface angle of distal tibia (TAS), talar tilt of ankle joint (TT), lateral surface angle of distal tibia (TLS), and heel alignment distance (HD).Results:The mean age of the patients was 61.6±18.2 years and the average follow-up period was 24.3±7.3 months. 13 subjects were in Depression group and 27 subjects were in Non-depression group. There was no statistical difference in baseline characteristics between the two groups. Additionally, there was no statistical difference in preoperative VAS and AOFAS between the two groups (p>.05). Preoperative and postoperative VAS and AOFAS showed statistically significant improvement in both groups (p<.05). However, the depressive group showed higher result in postoperative VAS than the Non-depressive group significantly (3.1±2.4 vs 1.4±2.3, p<.05). The postoperative AOFAS was also higher in the non-depressive group significantly (89.3±13.4 vs 95.0±8.1, p<.05). Both groups showed improvement in postoperative radiologic index. Preoperative and postoperative radiologic index showed no difference in both groups.Conclusion:The clinical outcome after TAA was poor in patients with depressive symptoms when compared to patients without depressive symptoms. Since depressive symptoms is a patient-specific factor that result in less improvement in clinical outcomes after TAA, clinical considerations for depressive symptoms are needed prior to TAA surgery.