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Patient and Practice Trends in Total Ankle Replacement and Tibiotalar Arthrodesis in the United States From 2007 to 2013

Vakhshori, Venus, MD; Sabour, Andrew F., BS; Alluri, Ram K., MD; Hatch, George F. III, MD; Tan, Eric W., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: January 15, 2019 - Volume 27 - Issue 2 - p e77–e84
doi: 10.5435/JAAOS-D-17-00526
Research Article

Introduction: Both total ankle replacement (TAR) and tibiotalar arthrodesis (TTA) are used in the surgical management of ankle arthritis. Over the past decade, TAR instrumentation, techniques, and implants have improved, making the procedure more reliable and reproducible, thus making TAR more common.

Methods: The Nationwide Inpatient Sample database from 2007 to 2013 was used to obtain data on patients elder than 50 years who underwent either TAR or TTA. Differences in temporal, demographic, and diagnosis trends between TAR and TTA were analyzed.

Results: Between 2007 and 2013, 15,060 patients underwent TAR and 35,096 underwent TTA. Patients undergoing TTA had significantly more comorbidities (2.17 versus 1.55; P < 0.001). The share of TAR performed increased significantly from 2007 (14%) to 2013 (45%) (P < 0.001). From 2007 to 2013, we found a 12-fold increase in the odds of having a TAR for patients with posttraumatic osteoarthritis (P < 0.001), a 4.9-fold increase for those with primary osteoarthritis, and a 3.1-fold increase for patients with rheumatoid arthritis (P < 0.001).

Conclusions: Over the past decade, the frequency of TAR has increased, particularly in patients with posttraumatic arthritis and osteoarthritis. Surgeons still perform TAR in healthier patients compared with TTA; however, because surgeons become more experienced with the technique, patients are undergoing TAR at a markedly higher rate.

Level of Evidence: Level III: retrospective comparative study

From the Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Correspondence to Dr. Vakhshori:

Dr. Alluri or an immediate family member has stock or stock options held in Axogen, Medtronic, Stryker, and Zimmer Biomet and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research-related funding (such as paid travel) from Acumed, Arthrex, and Trimed. Dr. Hatch or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of and serves as a paid consultant to Arthrex. Dr. Tan or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Arthrex and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the American Foot Ankle Society. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Vakhshori and Mr. Sabour.

© 2019 by American Academy of Orthopaedic Surgeons
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