Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost

Abstract

Background Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. Methods Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. Results A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA ( P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group ( P < .001). Patients younger than 65 years had both higher complication and revision rates. Discussion TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. Levels of Evidence: Level III: Retrospective comparative study

Trends and Reported Complications in Ankle Arthroplasty and Ankle Arthrodesis in the State of New York, 2009-2018

“…In contrast, SooHoo et al 24 found that arthroplasty was associated with increased rates of device-related infection and need for revision surgery, though their complications were assessed at 5 years postprocedure, whereas this study only documented up to 1 year from surgery. Other studies have agreed with SooHoo et al in finding increased rates of revision for ankle arthroplasty compared to arthrodesis years after the procedure, 19 , 26 but that short- and intermediate-term complication rates are similar between the 2 procedures. 12 , 16 , 26 However, higher rates of complications in patients undergoing fusion is not particularly surprising given higher comorbidity patients are more likely to be considered for arthrodesis, a trend that was observed in the present study.…”

“…Other studies have agreed with SooHoo et al in finding increased rates of revision for ankle arthroplasty compared to arthrodesis years after the procedure, 19 , 26 but that short- and intermediate-term complication rates are similar between the 2 procedures. 12 , 16 , 26 However, higher rates of complications in patients undergoing fusion is not particularly surprising given higher comorbidity patients are more likely to be considered for arthrodesis, a trend that was observed in the present study. This also likely explains the relative increased length of stay following ankle fusion, as patients with greater comorbidities may stay longer for medical management as well as skilled nursing care placement.…”

Complications Following Total Ankle Arthroplasty Versus Ankle Arthrodesis for Primary Ankle Osteoarthritis

“…While removal of hardware such as medial malleolar screws following TAR is comparatively less common, deep implant removal accounts for a large proportion of reoperations following AA. 29 Tucker et al recently reported comparable rates of hardware removal following AA at 1 year (18.8% 29 vs 15.0%). The present study also found patients that received AA were more likely to sustain a periprosthetic fracture at each postoperative follow-up.…”

Reoperation Rates Following Total Ankle Arthroplasty Versus Ankle Arthrodesis for Posttraumatic Indications

“…Rates of at least 1 reoperation were higher in the AA cohort both at 1 year (305 [35.4%] Post hoc power analysis using the effect size showed this study was powered at 14.4% and 20.3% for PJI at 1 year and 2 years, respectively, and powered >90% for all other complications. To achieve 80% power and detect small differences in rates of PJI at 2 years postoperatively between the AA and TAR cohorts, assuming expected incidence reported in recent literature, 18 the cohorts would have to be 1057.…”