Factors Contributing to Hospital Stay and Total Inpatient Charges in Total Ankle Arthroplasty: Review of the National Inpatient Sample

2017 ◽  
Vol 11 (3) ◽  
pp. 230-235 ◽  
Author(s):  
Jason L. Codding ◽  
Benjamin M. Zmistowski ◽  
Daniel E. Davis ◽  
Mitchell G. Maltenfort ◽  
David I. Pedowitz
Keyword(s):  
Regional Differences ◽  
Cost Effective ◽  
Total Ankle Arthroplasty ◽  
Hospital Charges ◽  
National Inpatient Sample ◽  
Private Hospitals ◽  
Ankle Arthroplasty ◽  
Effective Care ◽  
Significant Difference ◽  
End Stage

Total ankle arthroplasty (TAA) is commonly performed for end-stage ankle osteoarthritis. Given rising costs and declining reimbursements, identifying variables increasing length of stay (LOS) and total inpatient charges (TICs) of TAA is necessary for providing cost-effective care. The National Inpatient Sample (NIS) database was reviewed between 1993 and 2010, identifying LOS and TIC for TAA. Using a multivariate analysis, patient comorbidities, demographics, payment, and hospital details were evaluated. Median LOS decreased from 5 to 2 days, whereas median TICs increased from $21 382.53 to $62 028.00. Regionally, the South and Midwest had decreased TICs, whereas the West had an increased TIC. There was no significant difference in LOS geographically. Rural hospitals demonstrated decreased TICs, whereas urban private hospitals showed decreased LOS and decreased TICs. Large hospitals were associated with increased LOS and TICs. Compared with Medicare, private insurers demonstrated decreased LOS with equivalent TICs. Diabetics significantly increased mean LOS by 1 day, without a significantly increased TIC. Despite a decreased LOS, hospital charges have increased between 1993 and 2010 in TAA. We found that regional differences and hospital characteristics were associated with differences in LOS and TICs. Identification of these factors provides important information to facilities and surgeons. Levels of Evidence: Level IV: Economic/decision analysis

scholarly journals Modern total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis

2020 ◽  
Vol 12 (3) ◽  
Author(s):  
Cort D. Lawton ◽  
Adam Prescott ◽  
Bennet A. Butler ◽  
Jakob F. Awender ◽  
Ryan S. Selley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Treatment Options ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
P Value ◽  
Eligibility Criteria ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
End Stage

The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the evolution of both procedures. No randomized controlled trials exist due to the vast differences in surgical goals, patient expectations, and complication profiles between the two procedures. This makes high quality systematic reviews necessary to compare outcomes between these two treatment options. The aim of this study was to provide a systematic review with meta-analysis of publications reporting outcomes, complications, and revision data following third-generation TAA and/or modern AA published in the past decade. Thirtyfive articles met eligibility criteria, which included 4312 TAA and 1091 AA procedures. This review reports data from a mean follow-up of 4.9 years in the TAA cohort and 4.0 years in the AA cohort. There was no significant difference in overall complication rate following TAA compared to AA (23.6% and 25.7% respectively, P-value 0.31). Similarly, there was no significant difference in revision rate following TAA compared to AA (7.2% and 6.3% respectively, P-value 0.65). Successful treatment of end-stage tibiotalar arthritis requires an understanding of a patients’ goals and expectations, coupled with appropriate patient selection for the chosen procedure. The decision to proceed with TAA or AA should be made on a case-by-case basis following an informed discussion with the patient regarding the different goals and complication profiles for each procedure.

Comparison of Clinical Outcomes Between Ceramic-Based Total Ankle Arthroplasty with Ceramic Total Talar Prosthesis and Ceramic-Based Total Ankle Arthroplasty

2021 ◽  
pp. 107110072110513
Author(s):  
Tetsuya Yamamoto ◽  
Kanto Nagai ◽  
Noriyuki Kanzaki ◽  
Kiminari Kataoka ◽  
Koji Nukuto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Revision Rate ◽  
Clinical Results ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Small Series ◽  
Significant Difference ◽  
End Stage

Background: Total ankle arthroplasty (TAA) has become one of the standard surgical treatments for patients with end-stage ankle osteoarthritis (OA). In recent years, TAA with total talar prosthesis (combined TAA) has been used for ankle OA patients with talar osteonecrosis, with severe talar collapse, or with subtalar joint OA. The purpose of this study was to investigate the functional and clinical outcomes of combined TAA, compared with conventional TAA. Methods: Forty-six ankles (44 patients, 32 women/12 men) that underwent conventional TAA with mean follow-up of 42 months, and 26 ankles (25 patients, 18 women/7 men) that underwent combined TAA with mean follow-up of 46 months were included. Clinical outcomes, which included ankle range of motion (ROM), the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), and complications were compared between the groups. Results: The preoperative ROM was significantly worse in combined TAA for both dorsiflexion and plantarflexion; however, in the final ROM, there was no significant difference between the groups. There was no significant difference in JSSF scale and SAFE-Q between the groups. Revision rate was 10.9% in conventional TAA and 0% in combined TAA. Conclusion: In this small series, at an average of 3.5 years, we found no significant difference in clinical results between conventional TAA and combined TAA; however, the revision rate was higher in conventional TAA. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Mobile Anatomical Total Ankle Arthroplasty—Improvement of Talus Recentralization

2021 ◽  
Vol 10 (3) ◽  
pp. 554
Author(s):  
Faisal Alsayel ◽  
Mustafa Alttahir ◽  
Massimiliano Mosca ◽  
Alexej Barg ◽  
Mario Herrera-Pérez ◽  
...  
Keyword(s):  
Tibial Component ◽  
Mobile Bearing ◽  
Clinical Results ◽  
Total Ankle Arthroplasty ◽  
Premature Failure ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
The Mean ◽  
End Stage

Introduction: Total ankle arthroplasty (TAA) is becoming a more frequent treatment option for end-stage ankle osteoarthritis (OA) as outcomes measures are improving. However, there is concern that malalignment of TAA can result in premature failure of the implant. One of the malalignment issues is the talar sagittal malposition. However, a consensus on the significance of the sagittal translation of the talus in TAA is yet to be established. The aim of this study was, therefore, to clarify whether talus OA subluxation is normalized after the implantation of a mobile TAA. Methods: Forty-nine consecutive patients with symptomatic end-stage ankle OA underwent 50 cementless three-component mobile-bearing VANTAGE TAA with 21 right ankles (42%) and 29 left ankles (58%). Clinical and radiographic outcomes were assessed: Clinical variables: American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (0–100), visual analogue scale (VAS, 0–10), and ankle range of motion (ROM). Radiological variables: medial distal tibial articular angle (mDTAA), anterior distal tibial articular angle (aDTAA) and lateral talar station (LTS). Results: The clinical results showed the mean improvement in AOFAS hindfoot score from 42.12 ± SE 2.42 (Range: 9–72) preoperatively, to 96.02 ± SE 0.82 (Range: 78–100) at a mean follow-up of 12 months, with a highly statistically significant difference (p < 0.00001). Pain score (VAS) was 6.70 ± SE 0.28 (Range 0–10) preoperatively, and 0.26 ± SE 0.12 (Range: 0–3) at 12-month follow-up, with a highly statistically significant difference (p < 0.00001). ROM measurements preoperatively showed a mean of 22.55° ± SE 1.51° (Range: 0–50°), which showed a statistically significant improvement (p < 0.0001) to 45.43° ± SE 1.56° (Range: 25–60°) 12 months postoperatively. The radiological analyses revealed the following results: On the coronal view, the mDTAA preoperatively was 88.61 ± SE 0.70 (Range: 78.15–101.10), which improved to 89.46 ± SE 0.40 (Range: 81.95–95.80) at 12 months (not statistically significant—p = 0.94). On the sagittal view, the preoperative values of the aDTAA showed 82.66 ± SE 0.84 (Range: 70.35–107.47), which improved to 88.98 ± SE 0.47 (Range: 82.83–96.32) at 12 months postoperatively, with a highly statistically significant difference between preoperative and 12-months values (p < 0.00001). The mean LTS values for all patients were 3.95 mm ± SE 0.78 (Range: −11.52 to 13.89) preoperatively and 1.14 mm ± SE 0.63 (Range: −10.76 to 11.75) at 12 months, with a statistically significant difference between preoperative and 12-month follow-up (p = 0.01). The review of the radiological TAA osteointegration at 12 months showed no cases of loosening of the implanted TAAs. Two cases (4%) showed a radiolucency and one case (2%) a cyst on the tibial component; no cases had a change on the talar component. No TAA complication/revision surgeries were documented. Conclusion: In the present study, the lateral talar station of anteriorly subluxated ankles showed a significant improvement, i.e., physiological centralization of the talus, in the postoperative period when a mobile-bearing TAA was performed. The anterior/posterior congruency between the talar component and the mobile polyethylene insert of the mobile-bearing VANTAGE TAA allows the sagittal translation of the talus relative to the flat tibial component, reducing the prosthesis strain and failure.

scholarly journals Effect of Travel Time and Distance on Outcomes in Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Kristin C. Caolo ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
Constantine A. Demetracopoulos
Keyword(s):  
Travel Time ◽  
Complication Rate ◽  
High Volume ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Linear Regression Models ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
Drive Time

Category: Ankle; Ankle Arthritis Introduction/Purpose: Surgeons who perform a higher volume of total ankle arthroplasty (TAA) are known to have decreased complication rates; evidence shows that low volume centers performing TAA have decreased survivorship when compared with high volume centers. Understanding differences in outcomes for patients traveling different distances for their TAA is important for future patients deciding where to travel for their surgery. No study has previously examined differences in outcomes of patients traveling different distances to a high volume center for their TAA. This study compares preoperative and postoperative PROMIS scores for patients undergoing total ankle arthroplasty who traveled less than and more than 50 miles for their TAA. We hypothesized that there would be no difference in outcome scores based on distance traveled or estimated drive time. Methods: This study is a single center retrospective review of 162 patients undergoing primary total ankle arthroplasty between January 2016 and December 2018. We collected the primary address as listed in the patient’s medical record and used the directions feature on Google Maps to estimate driving mileage and estimated driving time from the patient’s address to the hospital. To analyze the distance patients traveled, patients were divided into two groups: <50 miles traveled (n=91) and >50 miles traveled (n=71). To analyze the estimated drive time, patients were divided into two groups: <90 minutes (n=77), >90 minutes (n=85). We collected preoperative and most recent postoperative PROMIS scores for all patients. Differences in most recent post-operative PROMIS scores between distance groups and travel time groups were assessed using multivariable linear regression models, adjusting for the pre-operative score and follow-up time. Results: We found no significant difference in post-operative PROMIS scores between the two groups when analyzed for distance traveled or for estimated travel time after adjustment for pre-operative PROMIS score and follow-up time (Table 1). The average follow-up for all 162 patients was 1.49 years. Power analysis showed that with a sample size of 110 (55 in each group), we had 81% power to detect an effect size of 4. Patients saw an increase in their Physical Function scores and a decrease in their Pain Interference and Pain Intensity scores with postoperative scores better than population means (Table 1). Overall complication rate for the <50 miles group was 17.6%, 7.7% required surgery. The >50 miles group had an overall complication rate of 24.0%, 9.9% required surgery. Conclusion: Patients traveling further distances to a high volume orthopedic specialty hospital for their total ankle arthroplasty do not have different clinical outcomes than patients traveling shorter distances. This is particularly important for patients deciding where to have their total ankle arthroplasty surgery. Patients who travel further have the opportunity to be treated at a local academic center; however our results show that outcomes do not change when traveling further for total ankle arthroplasty. [Table: see text]

The Impact of Concomitant Ipsilateral Knee Pain on Functional Outcomes in Total Ankle Arthroplasty

2020 ◽  
pp. 193864002095089
Author(s):  
Michael J. Symes ◽  
Alastair Younger ◽  
Mario Escudero ◽  
Murray J. Penner ◽  
Kevin Wing ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Knee Pain ◽  
Functional Outcomes ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Pain Group ◽  
Ankle Arthroplasty ◽  
End Stage ◽  
The Impact ◽  
Disease Specific

In end-stage ankle arthritis, little is known about the impact of concomitant knee pathology, including the impact of ipsilateral knee pain on total ankle arthroplasty (TAA) outcomes. The aim of this study was to determine the prevalence of ipsilateral preoperative knee pain in patients undergoing TAA and analyze its impact on patient-reported functional outcome measures (PROMs). A retrospective review was performed on the Vancouver End Stage Ankle Arthritis Database at a single institution. In total, 114 patients were studied, with patient demographics collected preoperatively, including the presence or absence of knee pain. Postoperative follow-up was performed at 5 years, primarily analyzing disease-specific PROMs, including the Ankle Osteoarthritis Score (AOS) and Ankle Arthritis Score (AAS). Multivariate mixed-effects linear regression models compared the scores between the groups. In total, 31 patients (27.2%) presented with concomitant ipsilateral knee pain. Despite more females in the knee pain group (64.5% vs 36.1%) there were no other significant differences at baseline between the knee pain and no knee pain groups in terms of demographics or baseline primary disease specific PROMs. At 5 years, the patients with knee pain had significantly worse AAS (37.9 ± 23.8 vs 21.2 ± 16.3, P = .004) and AOS total scores (38.1 ± 24.1 vs 21.9 ± 15.5, P = .005) compared with the no-knee pain group. Both groups improved significantly from baseline across all outcome measures; however, the magnitude of improvement was less in the knee pain group. Our study demonstrated that over one-quarter of patients with end-stage ankle arthritis undergoing TAA present with ipsilateral concomitant knee pain. If present, it is associated with worse functional outcomes at the 5-year mark. Further studies are needed to evaluate if knee pain influences complications, implant failure rates, and survival. Levels of Evidence: Level III

Comparison of Intermediate-term Outcomes of Total Ankle Arthroplasty in Primary and Ligamentous Post-traumatic Osteoarthritis

2019 ◽  
Vol 40 (11) ◽  
pp. 1273-1281 ◽  
Author(s):  
Gun-Woo Lee ◽  
Asep Santoso ◽  
Keun-Bae Lee
Keyword(s):  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Primary Osteoarthritis ◽  
Post Traumatic ◽  
American Orthopaedic ◽  
End Stage

Background: Ankle ligamentous injuries without fracture can result in end-stage ligamentous post-traumatic osteoarthritis, which may cause ligamentous imbalance after total ankle arthroplasty (TAA). However, outcomes of TAA in these patients are not well known. The purpose of this study was to evaluate intermediate-term clinical and radiographic outcomes of TAA in patients with ligamentous post-traumatic osteoarthritis and compare them with results of TAA for patients with primary osteoarthritis. Methods: We enrolled 114 patients (119 ankles) with consecutive primary TAA using HINTEGRA prosthesis at a mean follow-up duration of 6.0 years (range, 3-13). We divided all patients into 2 groups according to the etiology of osteoarthritis: (1) primary osteoarthritis group (69 ankles) and (2) ligamentous post-traumatic osteoarthritis group (50 ankles). Results: There was no significant intergroup difference in mean Ankle Osteoarthritis Scale (AOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Short Form-36 Physical Component Summary, visual analog scale pain score, ankle range of motion, or complications at the final follow-up. However, the final tibiotalar angle was less corrected to 4.2 degrees in the ligamentous post-traumatic osteoarthritis group compared to 2.7 degrees in the primary osteoarthritis group ( P = .001). More concomitant procedures were required at the index surgery for the ligamentous post-traumatic osteoarthritis group ( P = .001). The estimated 5-year survivorship was 93.4% (primary osteoarthritis group: 91.3%; ligamentous post-traumatic osteoarthritis group: 95.8%). Conclusions: Clinical outcomes, complication rate, and 5-year survivorship of TAA in ankles with primary and ligamentous post-traumatic osteoarthritis were comparable with intermediate-term follow-up. Our results suggest that TAA would be a reliable treatment in ankles with ligamentous post-traumatic osteoarthritis when neutrally aligned stable ankles are achieved postoperatively. Level of Evidence: Level III, retrospective cohort study.

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