Preoperative anxiety and depression are associated with poorer patient-reported outcome following total ankle replacements

J.M. Leow, P.Y. Wong, H. Shalaby, J. Mckinley

Introduction: Patients with pre-operative anxiety/depression have been shown to have inferior patient reported outcome measures (PROMs) in major joint arthroplasty. There is some evidence to show that patients with anxiety/ depression have inferior SF36, AOFAS and VAS scores following total ankle replacements (TAR). However, these outcomes are not validated for ankle surgery. The aim of this study is to investigate the effect of anxiety/depression on PROMs using the Manchester-Oxford Foot Questionnaire (MOXFQ) following TAR.

Methods: This is a retrospectively reviewed cohort study using prospectively collected PROMs data from a single centre from 2012 to 2023. Anxiety/depression was assessed using the EQ-5D-3L. MOXFQ was used to assess outcome after TAR. Questionnaires were completed by patients pre-operatively and 1-year post-operatively. MOXFQ between patients with and without anxiety/depression were compared using two-tailed T-test with significance taken at p <0.05.

Results: 113 primary TARs were available for analysis. Mean follow-up time was 3.0 years(SD 2.5). Pre-operatively, 78(69.0%) patients reported no anxiety/depression, 35(31%) reported moderate/severe anxiety/depression. There is significant difference between pre-operative MOXFQ scores for patients with and without anxiety/depression (84.2±12.9 vs 71.7±13.2 respectively, p<0.001). This significance persisted in post-operative MOXFQ scores (patients with anxiety/ depression=42.0±31.1, patients without anxiety/depression=23.3±23.8; p=0.001). The improvement in MOXFQ before and after TAR was significant for both groups at p<0.001. There were no significant difference between the two groups (p=0.249) when considering the degree of change from pre- to post-operative MOXFQ scores.

Conclusion: This is the first study assessing the effect of anxiety/depression on an ankle surgery-specific PROM after TAR. Our results agree with previous literature in suggesting that PROMs are modulated by baseline mental health state in TAR patients. However, both groups report similar improvement in PROMs after TAR, and this should be considered when counselling patients pre-operatively.