Impacts of Psychiatric Medication Use in Total Ankle Arthroplasty

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Psychiatric medications are widely used to treat psychiatric disorders, yet their impact on total ankle arthroplasty (TAA) outcomes remains unclear. This study evaluates the association between preoperative psychiatric medication use and postoperative complications following TAA. Methods: The TriNetX database (2005-2025) was queried to identify patients undergoing TAA. Patients were stratified into two cohorts with minimum two-year follow-up: one with preoperative psychiatric medication use and one without. Propensity score matching was performed using a 1:1 ratio to control for potential confounders, including preoperative demographic characteristics, medical and psychiatric comorbidities, which resulted in each cohort consisting of 4,169 patients. After matching, psychiatric medication cohort (46.3% female) had a mean age of 53.3 years, mean body mass index (BMI) of 32.9 kg/m² (range 18.5-40), and a mean follow-up of 708.465 days (range 180-1095.75). The control cohort (46.3% female) had a mean age of 53.4 years, mean BMI of 32.2 kg/m² (range 18.5-40), and a mean follow-up of 733.254 (range 180-1095.75). Results: At six months, psychiatric medication use was associated with increased risks of pneumonia (RR: 1.727; 95% CI: 1.024–2.915), deep vein thrombosis (RR: 2.176; 95% CI: 1.228–3.859), and emergency department utilization (RR: 1.209; 95% CI: 1.012–1.443). At two years, these patients had higher risks of implant-related pain (RR: 1.410; 95% CI: 1.102–1.803) and mechanical loosening of the prosthesis (RR: 2.545; 95% CI: 1.269–5.106). They also demonstrated an increased risk for hardware removal (RD: 0.002; 95% CI: 0.001–0.004), though this difference is likely not clinically significant. Interestingly, the psychiatric medication cohort had a lower risk of wound dehiscence (RR: 0.357; 95% CI: 0.174–0.734). Conclusion: Patients with psychiatric medication use undergoing TAA are at higher risk of medical and implant-related complications. Patients should be aware that the preoperative medication usage may increase their risk of complications, though further research is needed to confirm this.