Trajectory of Recovery Following Total Ankle Arthroplasty Using Patient-Reported Outcomes Measurement Information System (PROMIS).

BACKGROUND

Total ankle arthroplasty (TAA) is a common method of treatment for end-stage ankle arthritis (ESAA). The utilization of Patient-Reported Outcomes Measurement Information System (PROMIS) allows for standardized assessment of patient-driven outcomes, but few studies have been published on outcomes of TAA using PROMIS. The purpose of this study was to describe the recovery trajectory of patients undergoing TAA for ESAA for up to 1 year after surgery using PROMIS scores for physical function (PF), pain interference (PI), and depression (DP).

METHODS

A retrospective review of patients undergoing TAA for ESAA over a 5-year period (January 2018-October 2023) was performed. Preoperative and postoperative PROMIS scores were collected and compared at multiple time points leading up to 1 year after surgery. Demographic variables were compared. All patients included in this study underwent primary TAA. Patients were excluded from this study if they had contralateral TAA within 1 year of the previous TAA, and/or they did not have 1 preoperative or at least 2 postoperative PROMIS scores.

RESULTS

In total, 109 patients met inclusion criteria with a mean age of 65.3 (SD 9.2) years. No patients undergoing TAA had Medicaid and 50% had Medicare. The mean PROMIS PF scores at 1, 3, 6 months and 1 year were 28.2, 38.5, 41.8, and 43.1, respectively. The mean PROMIS PI scores at 1, 3, 6 months and 1 year were 57.1, 59.2, 56.2, and 55.8, respectively. Most of the improvement for both PF and PI scores from preoperative occurred within the first 6 months of recovery, with average improvements of 5.0 points for PF and -8.4 points for PI. Patients had statistically and clinically significant improvements in PROMIS scores at multiple postoperative time points. Patients had statistically significant improvement in PROMIS scores through various time points in their recovery.

CONCLUSION

This study demonstrates that patients who underwent primary TAA have improvements in PROMIS scores at several different time points up to 1 year after surgery. Patients can expect an improvement in pain and function from baseline within 3 months from surgery. Most improvements occur within the first 6 months. More than half of the patients will achieve a PF and PI score within 1 SD of the national average by 6 months, but it can take up to a year for most patients to reach this. Understanding the trajectory of patient recovery at different time points after primary TAA can help set patient expectations and guide intervention.