Total Ankle Replacement Outcomes in Obese Patients with Minimum 10-Year Follow-Up.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 41970024.
- Also identified by DOI 10.2106/JBJS.OA.26.00054 and PMC identifier 13068458.
- Licence recorded as CC BY-NC-ND.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
Obesity rates continue to rise worldwide. Current evidence for total ankle replacement (TAR) in obese patients is conflicting, limited to short-term to mid-term follow-up. Therefore, the aim of this study was to assess long-term outcomes of obese versus nonobese TAR patients. This retrospective cohort study was undertaken at a quaternary institution. Groups were defined by body mass index (BMI) (kg/m<sup>2</sup>): ≥30 (obese) or <30 (nonobese). Primary outcome measures included the Ankle Osteoarthritis Scale (AOS) and Short-Form 36 (SF-36). Secondary outcomes described secondary procedures following TAR. Multivariable linear regression was completed for patient-reported outcomes measures (PROMs). The study included 515 TARs in 482 patients (236 ankles obese, 279 ankles nonobese) with a mean age of 64 years and mean follow-up of 13.2 years. 310 TARs had minimum 10-year PROMs follow-up for analysis. No statistically significant differences in AOS pain/disability and SF-36 Physical Component Summary/Mental Component Summary changes scores (preoperative to latest follow-up) were observed between the 2 cohorts. Obese patients had statistically worse AOS disability scores preoperatively (p = 0.01), while disability levels were comparable postoperatively. Multivariable linear regression analysis revealed BMI ≥30 was not associated with poorer outcomes when adjusting for age, sex, implant, preoperative PROM score, follow-up duration, arthritis etiology, or diabetes. The number of patients undergoing secondary procedures and the number of secondary procedures required between cohorts were similar (34.4% obese TARs vs. 37.6% nonobese TARs). TARs can be successfully undertaken in obese patients with long-term improvement in PROMs and no significant increase in incidence of secondary procedures similar to their nonobese counterparts. These findings challenge the perception of obesity as a relative contraindication to TAR and support its use in appropriately selected obese patients. Level III. See Instructions for Authors for a complete description of levels of evidence.