Sinkler MA, Karimi AH, El-Abtah ME, Feighan JE, Harlow ER, Vallier HA. Does Mental Health impact the outcomes of Total Ankle Arthroplasty? A Systematic Review. J Ment Health Clin Psychol (2023) 7(1): 28-35 Systematic Review Open Access Page 28 of 35 www.mentalhealthjournal.org JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY Does Mental Health impact the outcomes of Total Ankle Arthroplasty? A Systematic Review Margaret A. Sinkler 1 *, Amir H. Karimi 2 , Mohamed E. El-Abtah 2 , John E. Feighan 1 , Ethan R. Harlow 1 , Heather A. Vallier 2 1 University Hospitals, Case Western Reserve University, Cleveland, OH, USA 2 Case Western Reserve University School of Medicine, Cleveland, OH, USA Article Info Article Notes Received: January 26, 2023 Accepted: April 13, 2023 *Correspondence: *Dr. Margaret A. Sinkler. University Hospitals, Case Western Reserve University, Cleveland, OH, USA. Email: margaret.sinkler@uhhospitals.org © 2023 Sinkler MA. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. Keywords: Total ankle arthroplasty TAA Mental illness Mental health Psychiatric disorders Depression Abstract Studies have demonstrated that depression, anxiety, negave mood, and pain catastrophizing influence outcomes following total hip, knee, and shoulder arthroplasty thus providing evidence-based counseling on expected postoperave outcomes. The purpose of this review is to establish the prevalence of mental health condions, impact of mental health condions on paent-reported outcome measures, and the impact on length of stay and discharge disposion in paents undergoing total ankle arthroplasty (TAA). An online search ulizing the Cochrane Central Register of Controlled Trials, PubMed, Google Scholar, and CINAHL databases was performed to idenfy relevant arcles published between 2010 and 2022. Seven studies were included in the systemac review. Depression was the most common mental health comorbidity with a pooled prevalence of 12.9%. Mental health comorbidies were associated with inferior paent reported outcomes measures. Addionally, depression was a pre-operave predicve factor in poor outcomes when ulizing the PROMIS score. The presence of a mental health comorbidity demonstrated an increased risk of nonhome discharge, length of stay, complicaon rate, infecon, and narcoc use. Psychiatric comorbidies, parcularly depression, were predictors of negave postoperave outcomes. This review reinforces the significant impact of mental health disorders and psychiatric comorbidies on clinical outcomes following TAA. Level of Evidence: Level III Introduction Ankle osteoarthritis (OA) is a major cause of disability with an incidence of 47.7 per 100,000 thus affecting 1% of the world population 1,2 . Ankle OA has been shown to have a similar impact on mental and physical disability compared to end-stage heart failure and hip arthritis 3,4 . The two main surgical treatments include ankle arthrodesis and total ankle arthroplasty (TAA). Historically, ankle arthrodesis was the treatment of choice for ankle OA but it may lead to inferior functional outcomes compared to arthroplasty and may hasten adjacent joint degeneration. The popularity of TAA as a viable treatment strategy for ankle OA is increasing as it mitigates some of the negative functional consequences associated with arthrodesis while also achieving similarly excellent pain relief. While early generations of TAA implants had poor clinical results and high rates of aseptic loosening, recently reported intermediate and long term outcomes have suggested that TAA is comparable in regard to complication and revision rates 5,6 . While a prior systematic review demonstrated that age, obesity,