# Psychological status and clinical outcomes in ankle arthrodesis: preoperative predictors and postoperative changes

## TL;DR

This study shows that patients with ankle arthritis who have anxiety or depression before surgery have worse outcomes after ankle fusion, despite overall improvements in pain and function.

## Contribution

The novel contribution is identifying preoperative anxiety/depression as a predictor of poorer postoperative outcomes after ankle arthrodesis.

## Key findings

- 48% of patients with end-stage ankle OA had preoperative anxiety or depression.
- Ankle arthrodesis improved pain, function, and psychological status in both groups, but Group A (with anxiety/depression) had worse overall outcomes.
- Preoperative psychological status significantly correlates with postoperative prognosis after ankle arthrodesis.

## Abstract

The aim of this study is to investigate the psychological status of patients with end-stage ankle osteoarthritis (OA), and to evaluate the impact of ankle arthrodesis (AA) on the patients’ psychological condition, as well as the influence of preoperative anxiety and depression symptoms on the clinical outcomes after AA surgery.

A retrospective observational study was conducted on 62 patients with end-stage ankle OA who underwent AA treatment at our hospital from January 2019 to December 2024. Based on the patients’ preoperative psychological status, they were divided into two groups: those with symptoms of anxiety/depression were included in Group A, and those without symptoms of anxiety/depression were included in Group B. The Hospital Anxiety and Depression Scale (HADS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Visual Analogue Scale (VAS) for pain were used to evaluate the patients before surgery and at the final follow-up. Independent sample t-tests and chi-square tests were used for between-group comparisons, and paired sample t-tests were used for within-group pre-post comparisons. P < 0.05 was considered statistically significant.

Of the 62 patients with end-stage ankle OA who were fully followed up, 30 had symptoms of anxiety/depression before surgery, a prevalence rate of up to 48%. All evaluation indicators for patients in Groups A and B improved significantly after AA surgery compared to before surgery, but the overall prognosis for Group A was worse than Group B.

AA can effectively improve patients’ pain, functional activity, and psychological condition, and there is a significant correlation between the patients’ preoperative psychological status and the prognosis.