Hi, my name is Hannah Nam and I am a third year medical student at the Penn State Hershey College of Medicine. I will be presenting our study on the effects of anxiety and depression and outcomes of patients with total ankle replacement. I would like to thank all of my co-authors and I would also like to thank the orthopedic surgery department at Penn State. Achieving adequate pain control following total ankle replacement or total ankle arthroplasty is important for minimizing post-operative complications and optimizing overall recovery. Understanding potential factors that are associated with increased or decreased pain following TAA may guide treatment and improve patient care. Previous studies have reported that pre-operative patient factors such as poor socioeconomic status, greater levels of anxiety and depression, greater pre-operative pain catastrophizing, poor self-efficacy, and poor coping skills are associated with worse outcomes following joint replacement surgery. However, the association between anxiety and depression in patient reported outcomes, specifically following TAA, is not well defined. The purpose of this study was to investigate the effects of anxiety and depression on post-operative reported pain control following TAA. Following institutional review board approval, a retrospective chart review was conducted for all patients who underwent TAA from 2018 to 2021 at our institution. Patients were separated into group A, which consisted of patients with no documented pre-operative history of anxiety and depression, and group B, which consisted of patients with a documented pre-operative history of anxiety or depression. Genomic data were recorded for all patients and electronic medical records were reviewed at two and six weeks following surgery to determine post-operative pain. Statistical analysis was then run to determine the relative risk of poorly controlled post-operative pain in patients with anxiety and depression. A total of 56 patients underwent TAA between 2018 to 2021 at our institution. In this cohort, the mean age of patients was 60.9 years old. 31 patients were male and 25 patients were female. The mean patient BMI was 33.8. Group A was comprised of 32 patients with no history of anxiety or depression. Four patients in this cohort reported poor pain control. Group B was comprised of 24 patients with a history of anxiety or depression. Four patients in this cohort reported poor pain control. There was no statistically significantly increased risk of poor pain control in patients with a history of anxiety or depression when compared to those with no history of anxiety or depression. Our results can be seen in figure one. The results from our cohort indicate that there is no significantly increased risk for poor pain control in patients with a history of anxiety and depression after total ankle replacement. The limitations of our study include the small sample size. We did not control for potential comorbid patient demographic factors or patient medical conditions that may have affected pain control. Also, our data was based on patients' subjective perspectives and perceptions of adequate pain control. Finally, the severity of anxiety and depression and treatment preoperatively was not considered in the data analysis. This is a preliminary study, and there are many opportunities for further investigation. First, we could expand the study and increase the sample size. With a larger patient population, we would be able to conduct multivariable analyses to determine whether other patient factors, such as sex, age, and BMI, have compounding effects with the patient's history of anxiety and depression and determine pain control. Additional studies may be conducted to determine whether psychological interventions or medical treatments of anxiety and depression before the TAA procedure has an effect on postoperative pain control. Finally, future studies could investigate the effects of anxiety and depression on other postoperative outcomes, such as patient satisfaction, level of function after surgery, range of motion after surgery, development of complications, and duration of opioid use following the procedure. Thank you very much for your attention.

Hannah Nam

medical student

total ankle replacement surgery

anxiety

depression