Association of Dementia With Total Ankle Arthroplasty and Ankle Arthrodesis Outcomes: A Short Report.

BACKGROUND

Foot and ankle surgeons evaluate older patients with ankle arthritis and dementia. In this report, we analyzed postoperative complications following ankle arthrodesis (AA) and total ankle arthroplasty (TAA), hypothesizing greater risk in patients with dementia.

METHODS

We conducted a retrospective cohort study using Medicare claims from 2016 to 2021, including beneficiaries aged ≥65 years who underwent TAA or AA. The primary independent variable was dementia, defined using the Charlson Comorbidity Index (CCI) dementia component based on International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes within 90 days before the index procedure. Outcomes included postoperative complications, all-cause readmissions, and mortality within 90 days and 12 months. Multivariable logistic regression models estimated adjusted differences in complication rates by dementia status.

RESULTS

Dementia was present in 0.56% of TAA patients (73 of 13 134) and 3.6% of AA patients (308 of 8519). With the numbers available, no significant differences could be detected with dementia in TAA using adjusted multivariable analyses, although 12-month readmissions were higher (P = .046). In contrast, among AA patients, dementia was associated with increased 90-day readmissions (P = .041) and higher 12-month mortality (P = .001), whereas other outcomes were not statistically significant.

CONCLUSION

We found differences in postoperative outcomes, particularly readmissions and mortality, in patients with dementia following AA. Conversely, we found limited differences in patients with and without dementia undergoing TAA, which may reflect limited power to detect modest differences given the smaller number of dementia patients in the TAA cohort. Further research should explore how the severity of cognitive impairment influences decision making in ankle arthritis treatment.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.