Does Mental Health impact the outcomes of Total Ankle Arthroplasty? A Systematic Review

Studies have demonstrated that depression, anxiety, negative mood, and pain catastrophizing influence outcomes following total hip, knee, and shoulder arthroplasty thus providing evidence-based counseling on expected postoperative outcomes. The purpose of this review is to establish the prevalence of mental health conditions, impact of mental health conditions on patient-reported outcome measures, and the impact on length of stay and discharge disposition in patients undergoing total ankle arthroplasty (TAA). An online search utilizing the Cochrane Central Register of Controlled Trials, PubMed, Google Scholar, and CINAHL databases was performed to identify relevant articles published between 2010 and 2022. Seven studies were included in the systematic review. Depression was the most common mental health comorbidity with a pooled prevalence of 12.9%. Mental health comorbidities were associated with inferior patient reported outcomes measures. Additionally, depression was a pre-operative predictive factor in poor outcomes when utilizing the PROMIS score. The presence of a mental health comorbidity demonstrated an increased risk of nonhome discharge, length of stay, complication rate, infection, and narcotic use. Psychiatric comorbidities, particularly depression, were predictors of negative postoperative outcomes. This review reinforces the significant impact of mental health disorders and psychiatric comorbidities on clinical outcomes following TAA. Level of Evidence: Level III