Trends in the use of total ankle replacement and ankle arthrodesis in the United States medicare population

Andrew J. Pugely, Xin Lu, Annunziato Amendola, John J. Callaghan, Christopher T. Martin, Peter Cram

Research output: Contribution to journalArticlepeer-review

72 Scopus citations

Abstract

Background: Total ankle replacement (TAR) has gained acceptance as an alternative to traditional ankle arthrodesis (AA)for end-stage ankle arthritis. Little is known about long-term trends in volume, utilization, and patient characteristics. Theobjective of this study was to use longitudinal data to examine temporal trends in TAR and AA.Methods: We identified all United States fee-for-service Medicare beneficiaries who underwent TAR and AA between1991 and 2010 (n = 5871 and 29 532, respectively). We examined changes in patient demographics and comorbidity,nationwide and hospital volume, per capita utilization, and length of stay (LOS).Results: Between 1991 and 2010, both TAR and AA patients had modest shifts in characteristics, with higher rates ofdiabetes and obesity. Overall, TAR Medicare volume increased by more than 1000% from 72 procedures in 1991 to 888in 2010, while per-capita standardized utilization increased 670.8% (P < .001). AA volume increased 35.8% from 1167procedures in 1991 to 1585 in 2010, while per-capita standardized utilization declined 15.6% (P < .001). The percentageof all US hospitals performing TAR increased nearly 4-fold from 3.1% in 1991 to 12.6% in 2010, while the proportionperforming AA remained relatively unchanged. LOS decreased dramatically from 8.7 days in 1991 to 2.3 days in 2010 inTAR and from 5.5 days to 3.2 days in AA (P < .001).Conclusion: Between 1991 and 2010, Medicare beneficiaries undergoing either TAR or AA became more medicallycomplex. Both volume and per-capita utilization of TAR increased dramatically but remained nearly constant for AA. Atthe same time, mean hospital volume for both procedures remained low. Further research should be directed towarddetermining design, surgeon, and hospital variables that relate to optimal outcomes following TAR, which has becomeincreasingly used for the treatment of ankle arthritis.Level of Evidence: Level III, comparative series.

Original languageEnglish (US)
Pages (from-to)207-215
Number of pages9
JournalFoot and Ankle International
Volume35
Issue number3
DOIs
StatePublished - Mar 2014

Bibliographical note

Funding Information:
The authors declared receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Cram is supported by a K24 award from NIAMS (AR062133) and by the Department of Veterans Affairs. This work is also funded in-part by R01 AG033035 from NIA at the NIH. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. No funding source had a role in the design or conduct of the study; data collection, management, analysis, or interpretation; or the preparation, review, or approval of the manuscript.

Funding Information:
Dr Cram is supported by a K24 award from NIAMS (AR062133) and by the Department of Veterans Affairs. This work is also funded in part by R01 HL085347 from the National Heart, Lung, and Blood Institute and R01 AG033035 from National Institute on Aging at the National Institutes of Health. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The funding sources had no role in the analyses or drafting of this article. None of the authors have any conflicts of interest. Dr Cram has received consulting fees from The Consumers Union (publisher of Consumer Reports Magazine ) and Vanguard Health Inc for work advice on quality improvement initiatives.

Keywords

  • CMS
  • Medicare
  • ankle arthrodesis
  • ankle fusion
  • outcomes
  • total ankle
  • utilization

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