Elizabeth Hofheinz, M.P.H., M.Ed.
Successful surgery=happy patient, right? This “equation” is thrown off when it comes to depressed people who undergo total ankle arthroplasty (TAA). A new study from Duke University, “The Impact of Preoperative Mental Health and Depression on Outcomes After Total Ankle Arthroplasty,” was published in the January 20, 2021 edition of The Journal of Bone and Joint Surgery.
Co-author James Nunley, M.D., an orthopaedic surgeon at Duke University Medical Center, told OSN, “We were seeing some patients who had terrible x-rays and then underwent ankle replacement and still we’re not tremendously satisfied with the result. So the impetus for the study was to see if their mental health was affecting the results of surgery.” 
Dr. Nunley and his colleagues delved into records on everyone at their facility who had a primary TAA between January 2007 and December 2016 who had participated in a prospective outcomes study and who had at least 1-year minimum follow-up. Four groups were established based on the presence or absence of a Short Form (SF)-36 mental component score of <35 and a diagnosis of depression.
“SF-36 Physical Component Summary (PCS) and MCS scores, Short Musculoskeletal Function Assessment function and bother components, and visual analog scale pain were collected preoperatively and in the 1 to 2-year follow-up,” wrote the authors.
“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.”
Dr. Nunley said to OSN: “The most important factor that we saw in our study was that patients who had pre-operatives low scores on the mental health portion of the SF 36, or who were depressed, didn’t get as much relief from an ankle replacement as patients without these problems. This data can then be used as a cautionary factor when counseling patients on how likely they were to improve after having an ankle replacement.”
