Impact of Age Decade on Surgical and Patient-Reported Outcomes Following Total Ankle Arthroplasty

Joydeep Baidya, Nana Amponsah, Kush Mody, David Pedowitz, Joseph Daniel, Selene Parekh

Introduction: Degenerative joint disease or post-traumatic arthritis of the ankle is often addressed using total ankle arthroplasty (TAA). Previous literature has examined outcomes at the extremes of the age continuum, but there are no studies tracking outcomes over time based on age. Thus, the purpose of this study was to compare surgical and patient-reported outcomes (PROM) between patients in different decades of life undergoing TAA. Method: Adult patients who underwent elective TAA at a tertiary care centre (2010-2024) were retrospectively identified and stratified into decades of life ranging from less than 50 to 80+ years old. Demographics/surgical characteristics were collected. Outcomes of interest were readmissions; revisions; time to weightbearing; time to return to daily activities; and PROMs of FAAM VAS and SF-12 PCS scores preoperatively and at 1 year postoperatively. Results: 787 patients who met inclusion criteria were identified (age < 50: 41; 50-59: 99; 60-69: 260; 70-79: 275; 80+: 112). The 80+ cohort had the lowest BMI (28.8 kg/m2; p = 0.002) and proportion of non-smokers (65.2%; p = 0.026), and highest Charlson Comorbidity Index (4.46; p < 0.001) and proportion of Medicare (59.8%; p < 0.001). Length of stay increased with each decade of life from 1.16 to 2.06 days (p < 0.001). Readmissions, revisions, and time to return to daily activities were comparable between age groups. Time to weightbearing was longest in the 80+ group (40.7 days; p = 0.037). Postoperative FAAM VAS and PCS scores were also best in the 80+ group (p < 0.001 and p = 0.043, respectively). Conclusion: This study identified that while length of stay increased with greater age, it was not associated with differences in readmissions, revisions, or recovery to baseline functionality. The favourable PROMs also indicate that older adults are satisfied with the outcomes of their surgery. Surgeons should be cognizant of the potential for adverse outcomes, but the otherwise comparable risk profile and PROMs suggest that TAA is safe and effective to perform in all age groups."