scholarly journals Population-based Projections of Ankle Arthrodeses

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023
Author(s):  
Christopher Gross ◽  
Justin Rabinowitz ◽  
Elizabeth Durante
Keyword(s):  
Age Groups ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Utilization Rate ◽  
Future Trends ◽  
United States Census ◽  
Ankle Arthritis ◽  
United States Census Bureau ◽  
Projection Model ◽  
Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is commonly performed for patients with end stage ankle arthritis. However, with improvements in long-term outcomes following total ankle arthroplasty it is possible that rates of ankle arthrodesis will decrease as utilization of ankle arthroplasty increases. The purpose of this study is to assess the current and future trends of ankle arthrodesis utilization. Methods: National Inpatient Sample (NIS) data from 1997-2014 was used to identify trends in the utilization of ankle arthrodesis. United States Census Bureau data from 1997-2014 was used to identify historical population data and future population estimates. A linear regression model was created using Mathematica v11.3 to project future demand for ankle arthrodesis. The data was stratified to show past and future trends based on gender and age. Results: The overall utilization rate of ankle arthrodesis remained relatively constant from 5897 procedures in 1997 to 5330 procedures in 2014. The overall demand for ankle arthrodesis is expected to increase slightly by 15 percent with 6141 procedures projected in 2045. Stratified by age groups, the number of procedures is predicted to decrease by 75% in ages 18-44 and 6% in ages 45-64, and predicted to increase by 133% in ages 65-84 by 2045. Stratified by gender, ankle arthrodesis is predicted to increase by 47% in males and decrease by 14% in females in 2045. Conclusion: Based on our projection model, the rate of ankle arthrodesis is predicted to stay relatively stable overall but decrease in younger populations. A projected increase in total ankle arthroplasty will likely contribute to decreased utilization of ankle arthrodesis. However, ankle arthrodesis will still be a valuable tool in the surgeon’s armamentarium to treat ankle arthritis.

scholarly journals Projections for Total Ankle Arthroplasty based upon the National Inpatient Sample

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023
Author(s):  
Christopher Gross ◽  
Justin Rabinowitz ◽  
Elizabeth Durante
Keyword(s):  
Age Groups ◽  
Population Data ◽  
Total Ankle Arthroplasty ◽  
Utilization Rate ◽  
National Inpatient Sample ◽  
United States Census ◽  
United States Census Bureau ◽  
Projection Model ◽  
Ankle Arthroplasty ◽  
Future Demand

Category: Ankle Arthritis Introduction/Purpose: The utilization of total ankle arthroplasty (TAA) has increased significantly over the past decade. While projections for hip and knee arthroplasty show an exponential increase in demand, there remains a paucity of literature on the projected demand for TAA. Outcomes for TAA show promising results at 10 year follow up and, as a result, the demand for TAA will likely see a significant increase over the next few decades. The purpose of this study is to assess the current trends and future demand of TAA utilization. Methods: National Inpatient Sample (NIS) data from 1997-2014 was used to identify trends in the utilization of TAA. United States Census Bureau data from 1997-2014 was used to identify historical population data and future population estimates. A linear regression model was created using Mathematica v11.3 to project future demand for total ankle arthroplasty. The data was stratified to show past and future trends based on gender and age. Results: The overall utilization rate of TAA increased from 232 procedures in 1997 to 4435 procedures in 2014. Based on our model, the overall demand for TAA is expected to increase by 174 percent to 12,161 procedures by 2045. Stratified by age groups, the number of procedures is predicted to increase by 69% in ages 18-44, 177% in ages 45-64, and 287% in ages 65-84 by 2045. Stratified by gender, males are projected to undergo 7,070 procedures and females are projected to undergo 6,114 procedures in 2045. Conclusion: Improvements in TAA techniques and implants are leading to better long term clinical outcomes following TAA. Based on our projection model, there is going to be a significant increase in demand for TAA by 2045.

scholarly journals Conversion of Ankle Fusions to Ankle Replacements

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0051
Author(s):  
Stephen White ◽  
Bruce Cohen ◽  
Carroll Jones ◽  
Michael Le ◽  
W. Hodges Davis
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
Fusion Site ◽  
Foot Function ◽  
Patient Related Outcome ◽  
Improved Function

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis remains a prominent treatment choice for ankle arthritis in a majority of patients. Long term studies have shown a compensatory development of ipsilateral adjacent joint arthritis after ankle arthrodesis, and some patients who receive an ankle arthrodesis develop pain in surrounding joints, or even at the fusion site. As total ankle arthroplasty (TAA) design, instrumentation, and techniques have improved, the use of total ankle arthroplasty has become more widespread. Very few studies have been published on conversion of ankle arthrodesis to ankle arthroplasty, but they have shown improved function and patient-related outcome scores. The purpose of this study was to assess the radiographic, clinical, and patient-reported outcomes of patients undergoing ankle arthroplasty after conversion from a CT-confirmed ankle arthrodesis. Methods: This was a retrospective cohort study of patients with previous CT-confirmed ankle arthrodesis who underwent conversion to total ankle arthroplasty. Minimum follow up was 1 year. Nonunions of ankle arthrodesis were excluded. AOFAS ankle-hindfoot score, foot function index (FFI), pain, revision surgeries, complications, and patient demographics were assessed. Radiographs prior to TAA, and at latest follow-up were also reviewed. Results: 10 patients were included in the study with an average age of 54.5 years. No implants had to be revised. 1/10 (10%) patients had to undergo secondary surgery for heterotopic ossification removal. The same patient had to undergo another subsequent surgery for posterior ankle decompression. 2/10 (20%) patients had a mild talar subsidence of the TAA at latest follow-up, with no patients having tibial subsidence. Talar osteolysis was noticed in 2 patients (20%) at latest follow-up, with no patients having tibial osteolysis. Only one patient (10%) was noted to have a mild valgus alignment of TAA with no varus malalignments. All radiographic changes noted were clinically asymptomatic. The average AOFAS total score was 58 (range 23,89). The mean FFI total score was 41.9 (range 0,90). Conclusion: Conversion of ankle fusion to TAA is a challenging operation but can be a viable option for patients with ongoing pain after an ankle arthrodesis. We noted low revision rates and few complications at 1 year.

scholarly journals Total Ankle Arthroplasty and Ankle Arthrodesis Utilization: An American Board of Orthopaedic Surgery (ABOS) Part II Database Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0012
Author(s):  
Christopher N. Carender ◽  
Natalie A. Glass ◽  
Annunziato Amendola ◽  
Kyle R. Duchman
Keyword(s):  
Patient Outcomes ◽  
Statistical Significance ◽  
Ankle Arthrodesis ◽  
Fellowship Training ◽  
Early Career ◽  
Total Ankle Arthroplasty ◽  
Training Status ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Technical Performance

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) utilization has increased over the last 20 years, while ankle arthrodesis (AAD) utilization has remained constant. However, annual hospital procedure volume for TAA and AAD remains low, with 50% of hospitals performing a median of =5 cases per year. Practicing in a low-volume setting may have implications for technical performance and patient outcomes, especially amongst early-career surgeons. The purpose of this study was to examine trends in utilization of TAA and AAD in ABOS part-II candidates while considering the influence of fellowship training status on treatment of end-stage ankle arthritis. Methods: The American Board of Orthopedic Surgery (ABOS) Part II database was queried to identify all candidates who performed =1 TAA or AAD from exam years 2009-2018. Candidates were categorized by exam year and by self-reported fellowship training status. Descriptive statistical methods were used to report procedure volumes. Trends in utilization of TAA and AAD were examined using log-modified regression analyses. Results: From 2009-2018, there was no significant change in the utilization of TAA or AAD amongst all candidates (p=0.92, p=0.20) (Table 1). Candidates reporting a foot and ankle (FA) fellowship trended towards increased utilization of TAA relative to AAD versus non-FA fellowship candidates, but this failed to reach statistical significance (p=0.06). The utilization of arthroscopic AAD increased over time (p<0.01) amongst all candidates. There was no difference in the rates of utilization of open versus arthroscopic AAD amongst FA trained candidates. High-volume (=5 TAA) candidates represented 10.5% of all candidates performing TAA, and accounted for 34.2% of all TAAs performed over the study period. Conclusion: Utilization of TAA and AAD did not change over the study period, and the number of these procedures performed by early-career surgeons remains low. The majority of both procedures are performed by FA trained surgeons with relatively low practice volumes. There was a trend toward increased TAA utilization relative to AAD utilization in FA trained surgeons, but this did not reach statistical significance. The findings in this study may have implications for technical performance impacting patient outcomes and may guide potential changes in training curricula.

scholarly journals Minimum 20 Year Follow-Up of Semi-Constrained Total Ankle Arthroplasty

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000
Author(s):  
Taylor Den Hartog ◽  
Samuel Carlson ◽  
Greg Alvine ◽  
Frank Alvine ◽  
Bryan Den Hartog ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
The United States ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Cobalt Chromium ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Entire Cohort ◽  
Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: With the introduction of newer generations of total ankle arthroplasty (TAA) constructs, the incidence of TAA in the United States has been increasing. While TAA has emerged as an alternative to ankle arthrodesis for the management of end-stage ankle arthritis, long-term data evaluating clinical outcomes and the survivorship of ankle prostheses is lacking. The purpose of this study was to report the clinical outcomes and radiographic survivorship of a second-generation, semi-constrained titanium and cobalt-chromium total ankle prosthesis at minimum twenty-year follow-up in order to provide a benchmark comparison for future generations of TAA design. Methods: 132 total ankle replacements in 126 patients were performed by a single surgeon between July 1984 and October 1994. Follow-up evaluation consisted of determining revision status, completion of the validated ankle osteoarthritis scale, a short questionnaire, and a review of the available radiographs. All radiographs were evaluated for evidence of progressive radiolucent lines, osteolysis and component subsidence. Results: At minimum twenty-year follow-up, 37 patients were alive, 89 were deceased, and 5 were lost to follow-up. For living patients, average clinical follow up was 25.3 years. Average radiographic follow-up was 21.4 years. Over the minimum 20 year follow-up, 29 ankles were revised (23%). For living patients, 13 ankles were revised (35%). Conclusion: Twenty-three percent of all patients and 35% of living patients required a revision over the minimum 20 year follow up interval. 65% of living patients have retained their prosthesis and 75% of the entire cohort are still functioning with their original ankle replacement or died with the original ankle replacement in place. This study should provide a benchmark for newer designs when they obtain this length of follow-up.

scholarly journals Total Ankle Arthroplasty vs Ankle Arthrodesis

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0001
Author(s):  
Thomas Clanton ◽  
Lauren Matheny ◽  
Angela Chang
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Proportional Hazard ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Cox Proportional Hazard ◽  
Age At Surgery ◽  
Significant Difference ◽  
Surgical Failure

Category: Ankle, Ankle Arthritis Introduction/Purpose: Ankle arthritis is a debilitating disorder which significantly limits activities of daily living and can lead to reduced quality of life. Total ankle arthroplasty(TAA) and ankle arthrodesis are common treatments for ankle arthritis; however, patient indications may differ based on individual patient needs. Few studies compare proportional hazard modeling, survivorship and patient-centered outcomes following these two procedures, which may be useful in determining the appropriate procedure for end-stage ankle arthritis in different patient populations. The purpose of this study was to determine proportional hazards for the risk of failure in patients who underwent TAA vs. arthrodesis, as well as survivorship and outcomes. Methods: All patients >18 years, between January 2009 and November 2013, who underwent TAA or ankle arthrodesis by a single surgeon for treatment of ankle arthritis were included. Patients completed a subjective questionnaire at minimum 2-years following index surgery. Outcomes measures included Foot and Ankle Ability Measure(FAAM), Foot and Ankle Disability Index(FADI), Lysholm, WOMAC, SF-12 physical component summary(PCS) and mental component summary(MCS), Tegner activity scale and patient satisfaction with outcome. Detailed surgical data/intraoperative findings were documented at time of surgery. All data were collected prospectively. Cox proportional hazard modeling and survivorship analysis were performed to assess differences between the two cohorts. Survivorship utilizing Kaplan-Meier method, using a log-rank test, was used to compare median survivorship. Cox-proportional hazard model was conducted to compare hazard rates of surgical failure for patients in each cohort, while adjusting for age at surgery, body mass index(BMI) and sex. All outcome measures were compared between cohorts. Results: There were 97 patients available for analysis. Eight patients failed surgery(9.2%). Demographic data were documented (Table 1). There was no significant difference in failures (TAA=2 failures (6.5%) vs. arthrodesis=6 failures (11.8%)(p=0.709). There was no significant difference in survivorship of surgery between the arthrodesis cohort and the TAA cohort(p=0.785)(Table 1, Figure 1). There was a decrease in survivorship at 4 years in TAA cohort compared to arthrodesis cohort, which was not significant. The hazard ratio was 0.804 [95%CI: 0.111–5.842], indicating that cohort did not have a significant effect on the hazard of surgical failure(p=0.829). Sex, age and BMI did not have a significant effect on the hazard of surgical failure(p>0.05). There was no significant difference in any outcome measures between cohorts(Table 1). Conclusion: There was no significant difference in survivorship or in the hazard of surgical failure based on cohort (TAA and arthrodesis) while accounting for sex, age at surgery and BMI. There was no significant difference in the hazard of surgical failure for factors including age at surgery, BMI or sex. There was no significant difference in survivorship or outcomes between cohorts. Total ankle arthroplasty seems to provide similar results as arthrodesis; however, there was a decrease in survivorship at 4 years in the TAA cohort. Although not significant, this may indicate that survivorship differs during the longer-term follow-up period.

Comparison of Intermediate-Term Outcomes of Total Ankle Arthroplasty in Patients Younger and Older Than 55 Years

2019 ◽  
Vol 40 (7) ◽  
pp. 762-768 ◽  
Author(s):  
Gun-Woo Lee ◽  
Jong‑Keun Seon ◽  
Nack-Sung Kim ◽  
Keun-Bae Lee
Keyword(s):  
Short Form ◽  
Survival Rates ◽  
Age Groups ◽  
Young Patients ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes

Background: Total ankle arthroplasty is often not recommended to younger patients with ankle arthritis because of their high functional demands. The purpose of this study was to compare intermediate-term clinical and radiographic outcomes and survivorship rates of total ankle arthroplasty between patients younger and older than 55 years. Methods: A total of 117 consecutive patients (123 ankles) who underwent primary total ankle arthroplasty using Hintegra prosthesis with a mean follow-up of 78 months were enrolled and divided into 2 age groups: under 55 years (38 ankles; mean age 45 years) and over 55 years (85 ankles; mean age 65 years). Results: Clinical scores of Ankle Osteoarthritis Scale pain and disability, American Orthopaedic Foot & Ankle Society ankle-hindfoot, Short Form–36 Physical Component Summary and Mental Component Summary, and visual analog scale were not significantly different between the 2 age groups at the final follow-up ( P > .05). There were no significant differences in complications and survivorship rates between the two at a mean follow-up of 78 months ( P > .05). Conclusions: Clinical and radiographic outcomes and survival rates of total ankle arthroplasty in patients under age of 55 years were satisfactory and comparable to those in patients older than 55 years in the intermediate-term follow-up. Therefore, total ankle arthroplasty may be considered as a viable treatment option in young patients with end-stage ankle arthritis. Level of Evidence: Level III, comparative series, therapeutic.

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