Level II, economic and decision analysis.

Background Total ankle arthroplasty (TAA) implantation is increasing, as the potential for pain relief and restoration of function and risks are compared with those for ankle fusion. A previous analysis with a simple decision tree suggested TAA was cost-effective compared with ankle fusion. However, reevaluation is warranted with the availability of newer, more costly implants and longer-term patient followup data. Questions/purposes Considering all direct medical costs regardless of the payer, we determined if TAA remains a cost-effective alternative to ankle fusion when updated evidence is considered. Patients and Methods Using a Markov model, we evaluated expected costs and quality-adjusted life years (QALY) for a 60-year-old hypothetical cohort with endstage ankle arthritis treated with either TAA or ankle fusion. Costs were estimated from 2007 diagnosis-related group (DRG) and current procedural terminology (CPT) codes for each procedure. Rates were extracted from the literature. The incremental cost-effectiveness ratio (ICER), a measure of added cost divided by QALY gained for TAA relative to ankle fusion, was estimated. To identify factors affecting the value of TAA, sensitivity analyses were performed on all variables.

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Direct repairs of both structures improved the stability of the joint but not back to normal. IO tendon transfer is a possible adjunct to collateral ligament repairs, but in itself is not sufficient to restore stability.

The risk of in-hospital mortality for injured children may be identified soon after arrival in the ED. This information may be used by frontline providers to appropriately triage patients to pediatric trauma centers quickly, to guide resuscitation, and for teaching purposes.