Preoperative Anxiety and/or Depression as a Predictor of Patient‑Reported Outcomes After Total Ankle Arthroplasty

Background: Psychological distress has been associated with inferior outcomes after major joint arthroplasty, but its impact on outcomes after total ankle arthroplasty (TAA) remains unclear. The main aim of this study was to investigate whether patients reporting anxiety or depression before TAA surgery had inferior outcomes 1 year after surgery. Methods: Retrospective analysis of prospectively collected data from a single-centre ankle arthroplasty registry. The exposure was preoperative anxiety/depression, defined from EuroQol–5 Dimensions–3 Level (EQ-5D-3L) item 5, and dichotomized, reflecting self-reported symptoms rather than a clinical diagnosis. The primary outcome was the adjusted difference between the exposure groups in the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ) score at 12 months postoperatively. Multivariable linear regression with multiple imputation of missing baseline MOxFQ was used to assess the association between preoperative anxiety/depression and 12-month MOxFQ, adjusting for baseline MOxFQ, age, sex, and diagnosis. Results: Three hundred patients were included, of whom 90 (30%) reported preoperative anxiety and/or depression. These patients were younger and reported worse baseline pain and function. Although patients with preoperative anxiety/depression had worse absolute MOxFQ scores at 12 months (mean 30.2 vs 20.1; P < .001), their improvement from baseline was comparable to patients without anxiety/depression (ΔMOxFQ 41.3 vs 43.9; P = .40). In multivariable regression analyses including baseline values, preoperative anxiety/depression was not independently associated with worse 12-month MOxFQ (β = 4.3; 95% CI −0.9 to 9.5). Among patients with baseline anxiety/depression, approximately two-thirds no longer reported anxiety/depression at 12 months. Conclusion: Preoperative self-reported anxiety or depression was common among patients undergoing TAA and was associated with worse symptoms before surgery. However, the reporting of such symptoms did not appear to limit postoperative improvement in patient-reported outcomes at 12 months. Among patients reporting anxiety/depression preoperatively, approximately two-thirds no longer reported anxiety/depression at 12 months. Level of Evidence: Level III, retrospective cohort study using prospectively collected registry data.