Total Ankle Replacement Outcomes in Obese Patients with Minimum 10-Year Follow-Up

Background: Obesity rates continue to rise worldwide. Current evidence for total ankle replacement (TAR) in obese patients is conflicting, limited to short-term to mid-term follow-up. Therefore, the aim of this study was to assess long-term outcomes of obese versus nonobese TAR patients. Methods: ): ≥30 (obese) or <30 (nonobese). Primary outcome measures included the Ankle Osteoarthritis Scale (AOS) and Short-Form 36 (SF-36). Secondary outcomes described secondary procedures following TAR. Multivariable linear regression was completed for patient-reported outcomes measures (PROMs). Results: The study included 515 TARs in 482 patients (236 ankles obese, 279 ankles nonobese) with a mean age of 64 years and mean follow-up of 13.2 years. 310 TARs had minimum 10-year PROMs follow-up for analysis. No statistically significant differences in AOS pain/disability and SF-36 Physical Component Summary/Mental Component Summary changes scores (preoperative to latest follow-up) were observed between the 2 cohorts. Obese patients had statistically worse AOS disability scores preoperatively (p = 0.01), while disability levels were comparable postoperatively. Multivariable linear regression analysis revealed BMI ≥30 was not associated with poorer outcomes when adjusting for age, sex, implant, preoperative PROM score, follow-up duration, arthritis etiology, or diabetes. The number of patients undergoing secondary procedures and the number of secondary procedures required between cohorts were similar (34.4% obese TARs vs. 37.6% nonobese TARs). Conclusions: TARs can be successfully undertaken in obese patients with long-term improvement in PROMs and no significant increase in incidence of secondary procedures similar to their nonobese counterparts. These findings challenge the perception of obesity as a relative contraindication to TAR and support its use in appropriately selected obese patients. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.