Association of Preoperative Psychiatric Medication Use With Complication Rates After Total Ankle Arthroplasty

BACKGROUND: Psychiatric medications are widely used in the United States, yet their effect on outcomes in patients undergoing total ankle arthroplasty (TAA) remains unclear. The purpose of this study was to determine the effect of preoperative psychiatric medication use on postoperative medical and surgical complications after TAA. METHODS: The TriNetX database (2005 to 2023) was queried to retrospectively identify patients who underwent TAA. Patients were stratified into two cohorts: one with preoperative psychiatric medication use within 1 year before operation (C1) and one without preoperative psychiatric medication use (C2). Propensity score matching was conducted using a 1:1 ratio to control for demographics and comorbidities. After matching, the psychiatry medication cohort consisted of 1,164 patients ,of whom 42.8% were female, with a mean age of 58.9 years, body mass index (BMI) of 30.8 kg/m2, and follow-up duration of 828.0 days (range, 730 to 1,095 days). The control cohort consisted of 1,164 patients, of whom 40.9% were female, with a mean age of 59.0 years, BMI of 30.5 kg/m2, and follow-up duration of 790.5 days (range, 730 to 1,095 days). RESULTS: At 6 months, patients in the psychiatric medication cohort had a significantly higher risk of acute respiratory failure compared with control subjects (risk differences [RD] = 0.009; 95% confidence intervals [CI], 0.003 to 0.014; P = 0.002). Conversely, treatment for wound dehiscence was more frequent among control subjects (RD = -0.009; 95% CI, -0.014 to -0.003; P = 0.002). At 2 years, the psychiatric medication cohort demonstrated higher risks of mechanical loosening (RD = 0.086; 95% CI, 0.060 to 0.112; P < 0.001), implant-related pain (RD = 0.021; 95% CI, 0.005 to 0.036; P = 0.008), and periprosthetic fracture (RD = 0.009; 95% CI, 0.003 to 0.014; P = 0.002). CONCLUSION: Preoperative psychiatric medication use is associated with markedly higher rates of long-term implant-related complications after TAA. Additional research is needed to elucidate mechanisms underlying these associations. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study.