Good afternoon. My name is Joseph Massalia, and I'll be presenting a study titled, Is Patient Resilience a Predictor of Postoperative Success Following Total Ankle Arthroplasty? The authors have no disclosures. Resilience is defined as the ability to adapt well to adversity or a significant source of stress, such as surgery. Prior orthopedic studies have demonstrated that, in general, patients with higher resilience are successful at managing their perioperative circumstances, leading to better functional outcomes postoperatively. No literature exists in patients who have undergone total ankle arthroplasty. The purpose of this study is to investigate whether patient resilience is a predictor of outcomes after total ankle arthroplasty. We hypothesize that patients with high resilience will have significantly improved pain, function, and satisfaction compared to patients with lower resilience. This was a single-institute, cross-sectional survey of patients who underwent primary total ankle arthroplasty with or without tendo-Achilles lengthening, or STRAIR, and or medial malleolar osteotomy. Patients with pre- and postoperative visual analog scale and foot and ankle ability measure scores were included. Patients who underwent revision or additional procedures other than those mentioned were excluded. A telephone survey was performed to obtain the patient's brief resilience scale scores and overall satisfaction with the survey. The BRS, or brief resilience scale, is a commonly used six-item Likert scoring system with each question scored one to five and higher scores reflecting increased resilience. Patients were defined as having low, normal, or high resilience based on an average BRS score of less than 3, 3 to 4.3, and greater than 4.3 per question, respectively. A total of 65 patients were included. There were 25, 38, and 2 patients in the low, normal, and high resilience groups, respectively. The high resilience group was excluded from statistical analysis given the very small sample size. When comparing outcomes of patients with low versus normal resilience, we found no statistically significant difference in VAS pain scores, foot and ankle ability measure functional scores, or satisfaction. Specifically, there was no statistically significant difference in postoperative VAS pain scores or the change in scores from pre to post-op. Likewise, there was no statistically significant difference in postoperative foot and ankle ability measure scores or the change in scores from pre to post-op. Over 80% of patients in both groups were either satisfied or very satisfied. There are multiple limitations to the study. There is inherent bias to surveys, such as sampling bias and response bias, sampling bias since patients may have not had the chance to respond, and response bias since patients with a stronger opinion are more likely to participate. Also, the sample size is small, especially in those considered to have high resilience, and since these patients were not included in the statistical analysis, it remains to be determined if there exists a difference in outcomes between a high versus a low resilience cohort. Lastly, patient reported outcomes of VAS pain and foot and ankle ability measure scores were not taken at the same time points postoperatively. We instead utilized the most recent completed score during routine follow-up. To our knowledge, this is the first study investigating the effect of patient resilience on outcomes following total ankle arthroplasty. We were unable to prove that patients with higher resilience have significantly improved outcomes compared to those with lower resilience. Despite this, patients in all three cohorts on average experienced decreased pain and improved function postoperatively. In addition, most patients were either satisfied or very satisfied with the surgery. Future studies should aim to increase the sample size as this may lead to results more consistent with previous orthopedic literature regarding resilience. Thank you.

Joseph Massalia

patient resilience

postoperative success

total ankle arthroplasty

resilience scoring system