Total Ankle Arthroplasty

O’Connor, Kathryn M.; Klein, Sandra E.; Ebeling, Patrick B.; Flemister, Adolph S.; Phisitkul, Phinit

doi:10.1177/2473011418790003

Cited by 5 publications

(4 citation statements)

References 48 publications

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“…In recent years, there have been improvements in TAR design. 25,32 The gait patterns achieved through operative intervention have been more similar to the natural patterns of the ankle, 20,36 and good outcomes have been reported. 16,20,31,36 As a consequence, the use of this alternative for the treatment of end-stage ankle OA has increased.…”

Section: Discussionmentioning

confidence: 69%

“…Total ankle replacement (TAR) use has increased among patients with end-stage ankle arthritis as an alternative to ankle arthrodesis (AA). 35 Improvements in design, 13,32 greater understanding regarding the mechanics of implants, 8,36 and surgeon’s experience 24 are all factors that have allowed an improvement in the results with different implants. 16,20,36 Furthermore, TAR has shown some advantages in preserving the range of motion, 3,15 better resembling normal foot kinematics and gait patterns compared to AA.…”

Section: Introductionmentioning

confidence: 99%

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Total Ankle Arthroplasty With Valgus Deformity

Piga

Maccario²,

D’Ambrosi

et al. 2021

Foot Ankle Int.

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Background: A substantial coronal plane deformity is common in the context of end-stage ankle osteoarthritis. Recent literature shows a trend toward extending the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing promising results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity were similar to those with no major deformity at short-term follow-up. Methods: This retrospective cohort study included 228 LTTARs. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10 degrees of coronal deformity, 209 patients) and valgus (above 10 degrees of valgus, 19 patients). Clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS), 12-Item Short Form Health Survey 12 (SF-12) regarding its Physical and Mental Component Summary items. The radiographic evaluation considered anteroposterior and lateral ankle radiographs. Complications were also registered and classified as major or minor. The minimum follow-up was 2 years. Results: The average AOFAS, VAS, and SF-12 scores improved significantly postoperatively ( P < .001), without differences between groups. At final radiographic follow-up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle, or anterior distal tibial angle ( P > .05). Conclusion: LTTAR in cases with valgus deformity achieved and maintained correction at short-term follow-up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless of preoperative valgus deformity. Level of Evidence: Prognostic Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Total Ankle Arthroplasty With Valgus Deformity

Piga

Maccario²,

D’Ambrosi

et al. 2021

Foot Ankle Int.

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“…11 Economic trends for TAA was performed by analyzing reimbursements to the provider, as done in previously published studies. [12][13][14][15] Data Analyses…”

Section: Study Variablesmentioning

confidence: 99%

Utilization Trends of Total Ankle Arthroplasty and Ankle Fusion for Tibiotalar Osteoarthritis: A Nationwide Analysis of the United States Population

Paracha

Idrizi

Gordon

et al. 2022

Foot & Ankle Specialist

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Introduction: Studies evaluating utilization and trends of total ankle arthroplasty (TAA) and ankle fusion (AF) are sparse. The purpose of this study was to use a nationwide administrative claims database to compare baseline demographics between TAA and ankle arthrodesis and to determine whether patients who had a TAA have increased rates of: (1) utilization, (2) in-hospital length of stay (LOS), and (3) costs of care. Methods: PearlDiver, a nationwide claims database was queried from 2005 to December 2013 for all patients who underwent primary TAA or AF for the treatment of osteoarthritis of the ankle and foot. Baseline demographics of age, sex, geographic distribution, and the prevalence of comorbidities comprising the Elixhauser comorbidity index (ECI) were compared between patients who had TAA and AF. Linear regression was used to compare differences in utilization and in-hospital LOS between the 2 cohorts during the study interval. Annual charges and reimbursement rates for TAA were assessed during the study period. A P value less than .05 was considered to be statistically significant. Results: A total of 21 433 patients undergoing primary TAA (n = 7126) and AF (n = 14 307) were included. Patients undergoing TAA had significantly greater ECI driven by arrythmias, congestive heart failure, diabetes mellitus, electrolyte/fluid disorders, iron deficiency anemia than patients undergoing AF (P < .001). From 2005 to 2013, TAA utilization increased from 21.5% to 49.4% of procedures (P < .0001). There was reduced in-hospital LOS over the time interval for patients with TAA compared with AF (2.15 days vs. 3.11 days, P < .0001). Total ankle arthroplasty reimbursements remained stable while charges per patient increased significantly from $40 203.48 in 2005 to doubling by the end of 2013 to $86 208.59 (P < .0001). Conclusion: This study demonstrated increased use of TAA compared to AF showing decreased in-hospital LOS and increased cost of care with stagnant reimbursement rates. Level of Evidence: Level III

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“…[9][10][11] The use of TAA as a mainstay of treatment for ankle disorders is on the rise, with 2825 TAAs versus 2665 ankle arthrodeses performed on inpatients in 2012. 12 Use of TAA in the United States has increased nearly 50% over the past 14 yr. 13 However, TAA presents a significant financial burden for the uninsured, or underinsured, patient because the associated costs can be four times as much as for ankle arthrodesis. 14 Importantly, even under ideal circumstances, functional survival rates for TAA are 10 to 15 yr, leaving younger and more active patients without a long-term solution for debilitating ankle PTOA.…”

Section: Introductionmentioning

confidence: 99%

Comparisons of initial outcomes and cost-effectiveness after total ankle arthroplasty versus bipolar osteochondral allograft transplantation in the ankle: a retrospective cohort study

Smith

Crist

Rucinski³

et al. 2021

Current Orthopaedic Practice

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Background:Total ankle arthroplasty (TAA) has been a standard-of-care surgical treatment option for patients who are suffering from ankle disorders since the 1960s. It is costly with a limited lifespan; younger, active patients will likely need additional surgeries. Evidence-based advancements in osteochondral allograft (OCA) preservation and transplantation techniques have resulted in improved outcomes, making it a potentially more appropriate treatment option for specific patients. This study compares 90-day clinical and self-reported outcomes for patients who received TAA or bipolar OCA ankle transplantation. Methods:Differences in costs and quality-adjusted life years (QALY) for patients were determined using postoperative 1-year follow-up. An institutional review board-approved review of electronic medical records and billing data was conducted for patients who underwent TAA or bipolar OCA ankle transplantation (n = 35) at a single institution between 2014 and 2018. Postoperative patient-reported outcome scores and cost comparisons were completed using a two-sample t-test, or nonparametric alternative, or chi-square test. Results:Three months after surgery, no statistically significant differences in patient-reported outcomes, postsurgical complications, or value-based care metrics were observed between older TAA (n = 18) or younger OCA groups (n = 17). Based on data, OCA and TAA were both considered cost-effective treatment options; differences in the incremental cost-effectiveness between OCA and TAA were not statistically significant (P = 0.99), and 1-year outcomes were good to excellent. Conclusions:These results will guide more robust planning for 90-day postoperative reimbursement guidelines. Ongoing work is needed to assess mid-term and long-term outcomes for patients with respect to morbidity, complications, patient-reported outcomes, costs, and QALY.

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Total Ankle Arthroplasty

Cited by 5 publications

References 48 publications

Total Ankle Arthroplasty With Valgus Deformity

Total Ankle Arthroplasty With Valgus Deformity

Utilization Trends of Total Ankle Arthroplasty and Ankle Fusion for Tibiotalar Osteoarthritis: A Nationwide Analysis of the United States Population

Comparisons of initial outcomes and cost-effectiveness after total ankle arthroplasty versus bipolar osteochondral allograft transplantation in the ankle: a retrospective cohort study

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