Patient Reported Outcome Measures (PROMIS) of Primary Total Ankle Arthroplasty in Patients Under 50 Years of Age

Abstract

Category: Ankle; Ankle Arthritis Introduction/Purpose: Compared to more prevalent arthritic conditions, ankle arthritis is complicated by an earlier age of onset. With advancements in 4th generation primary and revision componentry, total ankle arthroplasty (TAA) is considered an option for end-stage ankle arthritis in younger patients aligning with paradigm shifts in knee arthroplasty. Recently published data demonstrates excellent survivorship and complication rates in short/mid-term follow-up of younger patients who received a primary TAA. Additionally, older TAA patients display comparable PROMIS relative to hip/knee arthroplasty. However, there remains a paucity of literature surrounding the PROMIS of younger patients undergoing TAA. Thus, our aim was to assess PROMIS of individuals less than 50 years of age receiving a primary total ankle arthroplasty Methods: A retrospective cohort analysis of adult patients < 50 years who received a primary total ankle replacement at a single academic institution between 2003 and 2019 was conducted. Patient demographics, diagnosis, treatment, and outcome characteristics were recorded from a chart review of 41 patients with at least one year of post-surgical follow-up (Table 1). Post- operative PROMIS scores were obtained via telephone interviews. Primary outcomes that were measured included emotional and physical health, activity limitation, ambulation, and global health. SF-36, PROMIS Global Health, and Sickness Impact Profile Ambulation were used. Functional outcomes in our study sample were compared with age and gender-matched norms from a general US population, and 95% confidence intervals were calculated for each functional outcome mean. Student t-test was used for continuous variables, and chi-square analysis was used for categorical variables. Results: Thirty-one of 41 eligible patients were interviewed. The average age at surgery was 40 years old. Clinical and radiographic follow-up was a mean of 59.7 months and 31.2 months following TAA, respectively. General health as measured with the SF-36 was not significantly different from age/gender-matched norms. Eighty-seven percent of patients would choose to have a TAR again. While 58% reported being limited in vigorous activities, 61% were able to ambulate frequently for long periods of time. On average the patients did not report ongoing pain, and only 16% reported fatigue that hindered activities. Eighty-one percent reported returning to full employment and performing their duties without difficulty, and 84% reported they resumed all normal social activities. Primary implant survivorship was 88%. Conclusion: Despite a younger age and potentially increased demands, patients younger than 50 years of age undergoing primary total ankle arthroplasty are generally very satisfied with their index procedure at a mean follow-up of nearly 5 years. Our findings of positive outcomes on their health and well-being may improve surgeon insight for TAA as a preferred treatment for younger individuals with end-stage ankle arthritis.