Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review

Abstract

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Social determinants of health (SDOH) encompass environmental, institutional, and intrinsic conditions that can influence an individual's access to and utilization of healthcare over their lifespan. While SDOH effects are linked to disparities in patient-reported outcomes post hip and knee arthroplasty, their impact on total ankle arthroplasty (TAA) remains unclear. This study sought to examine how SDOH factors affect access to appropriate orthopedic treatment and their repercussions on patient-reported outcomes following TAA.

Methods:

In January 2024, a systematic review of the PubMed, Embase and the Cochrane Library was conducted to identify studies reporting at least 1 SDOH and its effect on access to health care, clinical outcomes, or patient-reported outcomes following TAA.

Results:

Fifty-eight studies, involving 212,944 patients, were analyzed. The INBONE system emerged as the most utilized Total Ankle Arthroplasty (TAA) system. Factors contributing to healthcare access delays included female gender, advanced age, worker's compensation claims, comorbidities, tobacco use, federally subsidized insurance, lower education, racial/ethnic minority status, low-income residence, low-volume surgery regions, unemployment, and preoperative narcotic use. Black patients experienced significantly worse postoperative clinical and patient-reported outcomes, along with heightened pain following TAA. Lower education level independently predicted poor surgical and patient-reported outcomes, increased pain, and lower patient satisfaction. Moreover, patients with federally subsidized insurance demonstrated significantly worse postoperative clinical and patient-reported outcomes.

Conclusion:

The impediments created by SDOH lead to worse clinical and patient-reported outcomes following TAA including increased risk of postoperative complications, TAA failure, higher rates of revision surgery, and decreased ability to return to work. Orthopedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR.