How Young is Too Young? A Study into Age-Related Outcomes for Total Ankle Replacement: Mean 72 Months Follow-Up of 812 Patients

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Total ankle replacement (TAR) is increasingly performed on patients across a wide age spectrum, though historically it has been reserved for older patients (>60). In this study, we seek to determine how age influences patient outcomes. Methods: This is a retrospective, comparative cohort study of consecutive patients that underwent TAR from 2004-2021. Patients were categorized into three age groups: ≤55, 56-70, and >70. We evaluated surgical complications and patient-reported outcome measures, including Ankle Osteoarthritis Pain & Disability Scores (AOS) and Short Form-36 Health Survey (SF-36). Analysis of covariance was performed, adjusting for patient factors. Results: We reviewed 812 consecutive TARs from a single-center with 407 (50.1%) male and mean BMI of 29.8±5.78. The mean follow up was 72.2 months. Patients ≤55 had worse pain preoperatively than both older patient groups (p=0.03) and worse mental health (p < 0.001), however, this difference was not observed in postoperative AOS pain (p=0.15) or SF-36 MCS scores (p=0.87). Patients >70 had worse physical health than patients 56-70 (p=0.02) and less change in pre- to postoperative SF-36 PCS scores (p=0.02). Patients from all groups improved similarly according to the AOS pain (p=0.15) and disability (p=0.12). Conclusion: These results show that TAR patients younger than 55 have worse pain and mental health preoperatively but have similar long-term clinical outcomes to patients 56 and older.