{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:16:37Z","timestamp":1787991397045,"version":"build-2784847793"},"reference-count":38,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Total ankle replacement (TAR) is increasingly used to treat end-stage ankle osteoarthritis, but the effect of obesity on complications and implant failure remains understudied. This study evaluates short- and midterm outcomes of TAR across body mass index (BMI) categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a retrospective database cohort using TriNetX Research Database, a federated national database of deidentified electronic medical records from more than 100 health care organizations (HCOs). Patients \u226518\u2009years who underwent primary TAR from 2014 to 2025 with minimum 2 years of follow-up were included. Patients were stratified by BMI: &lt;30 (nonobese), 30.0 to 34.9, 35.0 to 39.9, and \u226540. Our primary outcome was 5-year implant failure rate. Secondary outcomes included 90-day surgical site infections and major complications, as well as 1-year implant failure and 1- and 5-year periprosthetic joint infection (PJI) rates. Propensity-score matching (PSM) was performed comparing BMI\u2009&lt;30 and BMI\u2009\u226535.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 3533 patients (50% female; mean age across cohorts ranged 59-64\u2009years) were analyzed, including 1511 nonobese patients, 1118 with BMI 30.0 to 34.9, 608 with BMI 35.0 to 39.9, and 296 with BMI\u2009\u226540. At 90 days postoperatively, patients with BMI\u2009\u226540 had higher rates of major medical complications vs nonobese patients (OR 2.45, 95% CI 1.28-4.68;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.005). Also, by 90\u2009days, periprosthetic fracture risk was also elevated in patients with BMI 35.0 to 39.9 (OR 1.78, 95% CI 1.07-2.97;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.025) and \u226540 (OR 1.98, 95% CI 1.06-3.71;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.030). In propensity score matching, only the risk of 90-day medical complications remained elevated in patients with BMI\u2009\u226535. With the numbers available, no significant differences were observed in 5-year implant failure, with implant survival of 90.0% in patients with BMI\u2009&lt;30, 90.3% in BMI 30.0 to 34.9, 91.6% in BMI 35.0 to 39.9, and 86.4% in BMI\u2009\u226540. However, the study is underpowered to exclude clinically meaningful differences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>While 5-year implant survivorship appeared comparable across cohorts, patients with BMI\u2009\u226540 demonstrated a significantly higher risk of early postoperative medical complications. However, the study lacked sufficient power to definitively exclude clinically meaningful differences in long-term failure, particularly given the non-significantly lower survivorship in the morbidly obese.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level III, retrospective comparative study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007261427484","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T04:08:39Z","timestamp":1777003719000},"page":"725-734","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Obesity and Short- and Midterm Complications Following Total Ankle Replacement"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1637-789X","authenticated-orcid":false,"given":"Emily","family":"Teehan","sequence":"first","affiliation":[{"name":"George Washington University School of Medicine &amp; Health Sciences, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Shen","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine &amp; Health Sciences, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5737-2774","authenticated-orcid":false,"given":"Mir Saif","family":"Hossain","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine &amp; Health Sciences, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5039-2562","authenticated-orcid":false,"given":"Andrew","family":"Fealy","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine &amp; Health Sciences, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc D.","family":"Chodos","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, George Washington University Medical Faculty Associates, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.01180"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30059-4"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1938640020950147"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.N.00837"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/s21217114"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S275560"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.18.00313"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715606477"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v6.i1.137"},{"key":"e_1_3_2_11_2","unstructured":"Hales CM Carroll MD Fryar CD Ogden CL. 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