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

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Public health

Background:

• Rising global obesity rates necessitate evaluating surgical outcomes in this demographic.
• Existing evidence on total ankle replacement (TAR) in obese patients is limited and conflicting.
• Long-term outcomes of TAR in obese versus nonobese individuals require further investigation.

Purpose of the Study:

• To assess and compare the long-term outcomes of total ankle replacement (TAR) in obese (BMI ≥30) versus nonobese (BMI <30) patients.
• To evaluate patient-reported outcome measures (PROMs) and the need for secondary procedures after TAR in both groups.
• To determine if obesity is associated with poorer long-term results following TAR.

Main Methods:

• Retrospective cohort study including 515 TARs (236 obese, 279 nonobese) with a mean follow-up of 13.2 years.
• Primary outcomes included Ankle Osteoarthritis Scale (AOS) and Short-Form 36 (SF-36) scores.
• Multivariable linear regression analyzed the association between BMI and PROMs, adjusting for confounding factors.

Main Results:

• No statistically significant differences in long-term AOS and SF-36 scores between obese and nonobese TAR patients.
• Obese patients had worse preoperative disability scores, but postoperative scores were comparable.
• Obesity (BMI ≥30) was not associated with poorer outcomes after adjusting for multiple variables; secondary procedure rates were similar between groups.

Conclusions:

• Total ankle replacement (TAR) can be successfully performed in obese patients, yielding long-term improvements in PROMs comparable to nonobese patients.
• The incidence of secondary procedures following TAR is similar in both obese and nonobese cohorts.
• Findings suggest that obesity should not be considered a relative contraindication for TAR in appropriately selected patients.