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Total Ankle Arthroplasty: Does Obesity Matter?

Billy I Kim1, Albert T Anastasio1, Colleen M Wixted1

  • 1Duke University Department of Orthopaedic Surgery, Durham, NC, USA.

Foot & Ankle International
|June 22, 2023
PubMed
Summary

Obesity did not increase complication rates after total ankle arthroplasty (TAA). However, patients with obesity reported worse functional outcomes and quality of life post-TAA, despite similar PRO improvements across BMI groups.

Keywords:
body mass indexcomplicationsobesityoutcomespatient-reported outcomestotal ankle arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Patient-Reported Outcomes

Background:

  • Limited data exists on obesity's impact on total ankle arthroplasty (TAA) outcomes, particularly patient-reported outcomes (PROs).
  • Assessing obesity's effect on complication rates and PROs in TAA is crucial for clinical decision-making.

Purpose of the Study:

  • To evaluate the influence of obesity, stratified by BMI, on complication rates following primary TAA.
  • To determine the effect of obesity on patient-reported outcomes (PROs) after TAA.

Main Methods:

  • Retrospective analysis of 1093 primary TAA procedures (2001-2020) with a minimum 2-year follow-up.
  • Patients categorized into control (BMI 18.5-29.9), obesity class I (BMI 30.0-34.9), and obesity class II (BMI >35.0) groups.
  • Comparison of demographic data, complications, and PROs using statistical analyses, including multivariable Cox regression for implant failure risk.

Main Results:

  • No significant differences in postoperative complications (infection, implant failure, impingement) were observed across BMI classes.
  • Obesity class II patients exhibited lower preoperative Foot and Ankle Outcome Score pain and ADL subscales.
  • At final follow-up, both obesity classes I and II reported worse Short Musculoskeletal Function Assessment and 36-Item Short Form Health Survey scores compared to controls.

Conclusions:

  • Midterm follow-up indicates obesity is not associated with increased complication rates after TAA.
  • Patients with obesity experienced diminished musculoskeletal function and overall quality of life post-TAA.
  • No differential improvement in PROs was noted across BMI categories, suggesting obesity does not impede recovery progress disproportionately.