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O'Connor K, Klein S, Ebeling P, Flemister AS, Phisitkul P. Republication of "Total Ankle Arthroplasty: Summary of Current Status". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195063. [PMID: 37655936 PMCID: PMC10467185 DOI: 10.1177/24730114231195063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
| | - Sandra Klein
- Washington University in St Louis, Chesterfield, MO, USA
| | - Patrick Ebeling
- Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA
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Sambandam S, Senthil T, Serbin P, Viswanathan VK, Mounasamy V, Wukich D. Analysis of Baseline Characteristics, Length of Stay, Cost of Care, Complications and Subgroup Analysis of Patients Undergoing Total Ankle Arthroplasty-A Large Database Study. J Foot Ankle Surg 2023; 62:310-316. [PMID: 36163143 DOI: 10.1053/j.jfas.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/26/2022] [Accepted: 08/13/2022] [Indexed: 02/03/2023]
Abstract
Although total ankle arthroplasty (TAA) is becoming a progressively common procedure with a reported 10-fold increase in its prevalence over the past 2 decades; there is still limited large-scale data regarding its overall outcome. Using the National Inpatient Sample (NIS) database, patients who underwent TAA between 2016 and 2019 were identified (ICD-10 CMP code). Data regarding demographic details, co-morbidities, geographic locations of procedure, hospital stay, expenditure incurred, and complications encountered were analyzed. Additionally, a comprehensive subgroup analysis was performed to evaluate the impact of multiple preoperative variables (including gender, diabetes, obesity, CKD and tobacco abuse) on the patient outcome. Overall, 5087 patients (mean age: 65.1 years, 54% males, 85% Caucasians, 75% from large metropolitan regions) underwent TAA. Eighty eight percent of patients were discharged to home; and the mean length of hospital stay and hospital-related expenditure were 1.7 ± 1.41 days and $92,304.5 ± 50,794.1, respectively. The overall complication rate was 8.39% {commonest medical complications: anemia [131 (2.6%) patients) and acute renal failure [37 (0.7%) patients]; commonest local complication: periprosthetic mechanical adversities [90 (1.7%) patients]}. Female and CKD patients demonstrated significantly higher risks of medical (female: p = .003; CKD: p < .001) and surgical (female: p = .005; CKD: p < .019) complications; while obesity substantially enhanced the risk of medical adversities (p < .001). Based on our study, we could conclude that the rates of TAA in the United States are on the rise, especially in regions with population greater than 250,000. TAA is a safe procedure with relatively low complication rates. The complications and hospital-associated expenditure seem to vary between different patient subgroups.
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Affiliation(s)
- Senthil Sambandam
- Assistant Professor, University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, Dallas, TX.
| | | | - Philip Serbin
- Orthopedic Resident, University of Texas Southwestern, Dallas, TX
| | | | - Varatharaj Mounasamy
- Professor, Department of Orthopedics, University of Texas Southwestern, Chief of Orthopedics, Dallas VAMC, Dallas, TX
| | - Dane Wukich
- Professor and Distinguished Chair, Department of Orthopedics, University of Texas Southwestern, Dallas, Texas
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Randall E, Bryan S, Black C, Goldsmith LJ. What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement. BMC Musculoskelet Disord 2022; 23:845. [PMID: 36068507 PMCID: PMC9446772 DOI: 10.1186/s12891-022-05695-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 07/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Globally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA results and efforts need to be made to improve these rates. This study set out to identify what patients consider important when reflecting on TKA satisfaction, to pave the way to identifying service transformation opportunities that will enhance patient-centred care and satisfaction with this procedure. Methods Twenty-seven TKA recipients were recruited in the province of British Columbia, Canada. Semi-structured interviews were conducted about participants’ experience and satisfaction with TKA, three to four years post-surgery. Grounded theory was employed to analyze participants’ stories about what was front of mind when they reflected on satisfaction with their new knee. Results Participants described their post-TKA knee in terms its adequacy: how it felt and worked, and how it matched their pre-surgical expectations. The central element of their stories was the process of adapting, which gave rise to their perceptions of adequacy. Adapting comprises the patient experience of physically integrating and cognitively accepting their new knee. Patterns of adapting reflect the level of the new knee’s achieved adequacy and the straightforwardness of the adapting process. Discussion The conceptualization of adequacy and the process of adapting allow a patient-centred understanding of what patients experience following TKA. For participants who did not readily achieve the adequacy they had anticipated, the challenges they experienced during adapting dominated their stories. Participants’ adapting stories afford key insights into how the health care system could adjust to better support TKA patients, and improve rates of satisfaction with this procedure. Conclusions The process of adapting lends itself to system intervention in support of enhanced post-TKA outcomes and satisfaction. These interventions could include the development of a care model including long-term clinical support for patients whose knees do not achieve desired results on schedule, and collaborating with patients to set and manage reasonable expectations about how their post-TKA knee will feel and function.
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Affiliation(s)
- Ellen Randall
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. .,Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada.
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada
| | - Charlyn Black
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Health Services and Policy Research, Vancouver, Canada
| | - Laurie J Goldsmith
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,GoldQual Consulting, Toronto, Canada
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Place ZJ, Macdonald DJ, Clement ND, Shalaby H, McKinley JC. Primary total ankle replacement surgery is a cost-effective intervention. Foot (Edinb) 2021; 49:101830. [PMID: 34536817 DOI: 10.1016/j.foot.2021.101830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
AIMS The primary aim was to assess the cost-effectiveness of primary total ankle replacements (PTAR) in the UK. Secondary aim was to identify predictors associated with increased cost-effectiveness of PTAR. METHODS Pre-operative and six-month post-operative data was obtained over a 90-month period across the two centres receiving adult referrals in the UK. The EuroQol general health questionnaire (EQ-5D-3L) measured health-related Quality of Life (HRQoL) and the Manchester-Oxford Foot Questionnaire (MOXFQ) measured joint function. Predictors, tested for significance with QALYs gained, were pre-operative scores and demographic data including age, gender, BMI and socioeconomic status. A cost per QALY of less than £20,000 was defined as cost effective. RESULTS The 51-patient cohort [mean age 67.70 (SD 8.91), 58.8% male] had 47.7% classed as obese or higher. Cost per QALY gained was £1669, rising to £4466 when annual (3.5%) reduction in health gains and revision rates and discounting were included. Lower pre-operative EQ-5D-3L index correlated significantly with increased QALYs gained (p < 0.01), all other predictors were not significantly (p > 0.05) associated with QALYs gained. CONCLUSIONS PTAR is a cost-effective intervention for treating end-stage ankle arthritis. Pre-operative EQ-5D-3L was associated with QALYs gained. A pre-operative EQ-5D-3L score of 0.57 or more was not cost effective to operate on.
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Affiliation(s)
- Zach J Place
- The University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, United Kingdom.
| | - Deborah J Macdonald
- Department of Orthopaedics - Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - Nicholas D Clement
- Department of Orthopaedics - Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - Hisham Shalaby
- Department of Orthopaedics - Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - John C McKinley
- Department of Orthopaedics - Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
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Factors Influencing Quality of Life in Older Adults Following Hip Surgery. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mohammadi S, Miller WC, Wu J, Pawliuk C, Robillard JM. Effectiveness of eHealth Tools for Hip and Knee Arthroplasty: A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:696019. [PMID: 36188859 PMCID: PMC9397702 DOI: 10.3389/fresc.2021.696019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022]
Abstract
Objective: This study aimed to compare the effectiveness and costs of eHealth tools with usual care in delivering health-related education to patients' undergoing total hip or knee arthroplasty due to osteoarthritis.Data Sources: Six electronic databases were searched to identify randomized controlled trials and experimental designs (randomized or not) examining the effect of eHealth tools on pre- or post-operative care. Only manuscripts written in English were included. In the current study, no specific primary or secondary outcomes were selected. Any study that investigated the impacts of eHealth tools on hip or knee arthroplasty outcomes were included.Review Methods: Two researchers reviewed all titles and abstracts independently and in duplicate. Two researchers also conducted full-text screening and data extraction from the 26 selected articles.Results: The data were descriptively reported, and themes could emerge from each outcome. Two researchers separately assessed the Risk of Bias for each paper using the Cochrane risk of bias assessment tool. The majority of studies evaluated the impact of eHealth tools on physical (n = 23) and psychosocial outcomes (n = 19). Cost-related outcomes were measured in 7 studies. eHealth tools were found to be equivocal to usual care, with few studies reporting statistically significant differences in physical or psychosocial outcome measures. However, cost-related outcomes showed that using eHealth tools is more cost-effective than usual care.Conclusions: This review demonstrated that eHealth tools might be as effective as usual care, and possibly more cost-effective, a crucial implication for many overly burdened health care systems.
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Affiliation(s)
- Somayyeh Mohammadi
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William C. Miller
- GF Strong Rehabilitation Research Program, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Wu
- BC Children's and Women's Hospitals and Health Centres, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Colleen Pawliuk
- BC Children Hospital Research Institute, Vancouver, BC, Canada
| | - Julie M. Robillard
- BC Children's and Women's Hospitals and Health Centres, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Julie M. Robillard
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Liu X, Zhang H, Li Y, Chen Y, Deng W, Zhang W. Application of Negative Pressure Wound Therapy in Total Ankle Replacement. J Foot Ankle Surg 2021; 60:283-287. [PMID: 33223439 DOI: 10.1053/j.jfas.2020.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 02/08/2023]
Abstract
The efficacy and safety of incisional negative pressure wound therapy (iNPWT) was evaluated following total ankle replacement. A retrospective cohort study was conducted in patients who underwent total ankle replacement between January 2010 and June 2018. Following joint replacement, the patients received iNPWT (iNPWT group) or sterile dressings (Control group). Infection rate, wound complication incidence, length of stay, visual analogue scale, American Orthopedic Foot and Ankle Society, and short-form 36 scales, and ankle range of motion were assessed 1 week, 2 weeks, 1 month, 3 months, 6 months, and 12 months postoperatively. Thirty-four patients (n = 13 iNPWT and n = 21 Control) were included. No significant differences were found in baseline data. During follow-up, one Control patient developed a superficial infection at the incision. Wound complications developed in 4 Control patients and 1 iNPWT patient; although this was not statistically significant. Length of stay was similar between the 2 groups. Two weeks after surgery, the range of visual analogue scale (2.1 vs 1.4), American Orthopedic Foot and Ankle Society (13.7 vs 9.7), and short-form 36 scale (9.0 vs 6.5) improvement, and increase of ankle range of motion (9.2 vs 6.1) was significantly larger in the study group than in the control group (p < .05). Three months to 1 year after the surgery, this difference was no longer statistically significant. The application of iNPWT following total ankle arthroplasty helped reduce postoperative pain, improve ankle function, and improve patient quality of life. However, these benefits were no longer statistically significant 3 months to 1 year after surgery.
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Affiliation(s)
- Xi Liu
- Surgeon, Department of Orthopedic Surgery, West China Hospital, Chengdu, Sichuan Province, China
| | - Hui Zhang
- Surgeon, Department of Orthopedic Surgery, West China Hospital, Chengdu, Sichuan Province, China.
| | - Yaxing Li
- Surgeon, Department of Orthopedic Surgery, West China Hospital, Chengdu, Sichuan Province, China
| | - Yu Chen
- Surgeon, Department of Orthopedic Surgery, Shangjin Nanfu Hospital, Chengdu, Sichuan Province, China
| | - Wei Deng
- Surgeon, Department of Orthopedic Surgery, Shangjin Nanfu Hospital, Chengdu, Sichuan Province, China
| | - Wen Zhang
- Physician, Department of Neurology, the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gagne OJ, Veljkovic AN, Glazebrook M, Penner M, Wing K, Younger ASE. Agonizing and Expensive: A Review of Institutional Costs of Ankle Fusion Nonunions. Orthopedics 2020; 43:e219-e224. [PMID: 32271927 DOI: 10.3928/01477447-20200404-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
Nonunion after ankle arthrodesis requiring revision is a challenging operative complication, and bone graft substitutes are costly. This study sought to summarize all institutional expenditures related to the revision of an ankle fusion nonunion, presuming that cost and skin-to-skin time would exceed those of the index surgery. The electronic records from 2 foot and ankle centers were reviewed, leading to a list of patients with 2 or more entries for tibiotalar fusions being generated. A total of 24 cases were found to match the criteria. Demographic factors and skin-to-skin time of the remaining patients were compiled. This cohort included 24 patients (6 female and 18 male) with a mean age of 64 years and body mass index of 30.4 kg/m2. Supplemental clinic visits and investigations were included either after computed tomography to assess union or 365 days after index surgery. Total cost of the revision was calculated from billing codes, length of operation, and period of hospitalization. Postrevision outpatient fees were included as well. The revisions were performed open in all cases, and 21 patients received autograft and/or bone substitute. Mean postoperative hospitalization was 3 days. The additional costs (in US dollars) associated with nonunion were $1061 for imaging, $627 for prerevision visits, $3026 for the revision, $3432 for the hospital stay, and $1754 for postrevision follow-up. The total mean amount was $9683, equivalent to 9 nights of acute inpatient stay. Mean index skin-to-skin time was 114 minutes, being 126 minutes for revisions (P=.26). Additional care related to ankle fusion nonunion represents a financial burden equivalent to 9 nights of acute inpatient stay. The use of an orthobiologic would need to be less than $436 to be cost saving. Revision surgery is not significantly longer intraoperatively than index surgery. [Orthopedics. 2020;43(4):e219-e224.].
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Do preoperative patient-reported outcomes predict hospital length of stay for surgically-treated end-stage ankle osteoarthritis patients? Foot Ankle Surg 2020; 26:175-180. [PMID: 30773458 DOI: 10.1016/j.fas.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/07/2018] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND End-stage ankle arthritis is often debilitating, associated with diminished mobility, pain, and reduced health related quality of life. Direct hospital costs of AA and TAA differ, with hospital length of stay being a major contributor. The objective of this study is to test the association between four patient-reported outcome measures with hospital length of stay, potentially important for preoperative planning and care. METHODS This study is based on a prospective cohort of patients scheduled for AA or TAA for end-stage ankle arthritis in the Vancouver Coastal Health authority, Canada. Participants completed a condition-specific instrument, the AOS, and three generic instruments, the PHQ-9, PEG and EQ-5D(3L) shortly after being scheduled for surgery. Multivariate mixed-effects Poisson regression models were used to measure the association between preoperative patient-reported outcome measures and length of stay. RESULTS Among the 183 patients eligible to participate, the participation rate was 48.5%. There were 89 participants. Participants reported a high level of preoperative ankle impairment and pain. The adjusted results found no relationship between the AOS, EQ-5D(3L) VAS or PHQ-9 values and participants' LOS. Participants with at least one chronic health condition and lowest SES category had longer LOS. CONCLUSIONS This study found no evidence of an association between four PROs collected prior to AA or TAA with hospital LOS. This finding suggests collecting these PROs preoperatively may not help with discharge planning.
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Veljkovic AN, Daniels TR, Glazebrook MA, Dryden PJ, Penner MJ, Wing KJ, Younger ASE. Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis. J Bone Joint Surg Am 2019; 101:1523-1529. [PMID: 31483394 DOI: 10.2106/jbjs.18.01012] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND End-stage ankle arthritis is a disabling condition that has a similar effect on morbidity, pain, and loss of function to hip arthritis. We compared clinical outcomes of total ankle replacement (TAR) involving the HINTEGRA prosthesis (Integra LifeSciences), arthroscopic ankle arthrodesis (AAA), and open ankle arthrodesis (OAA) in patients with isolated, non-deformed end-stage ankle arthritis. METHODS Patients ≥18 years old who underwent TAR, AAA, or OAA from 2002 to 2012 with a minimum follow-up of 2 years were retrospectively identified from the Canadian Orthopaedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction Database. All patients had symptomatic COFAS Type-1 end-stage ankle arthritis without intra-articular or extra-articular deformity or surrounding joint arthritis. Clinical outcomes included the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36). Revision was defined as removal of 1 or both metal ankle prosthesis components for TAR and as reoperation for malposition, malunion, or nonunion for AAA and OAA. RESULTS Analysis included 238 ankles (88 TAR, 50 AAA, and 100 OAA) in 229 patients with a mean follow-up of 43.3 ± 18.5 months. The TAR group had more female patients (55%; p = 0.0318) and a higher mean age (p = 0.0005). Preoperative AOS pain, disability, and total scores were similar for all groups. SF-36 physical and mental component summary scores were similar across groups, both preoperatively and postoperatively. Improvement in AOS total score was significantly larger for TAR (34.4 ± 22.6) and AAA (38.3 ± 23.6) compared with OAA (25.8 ± 25.5; p = 0.005). Improvement in AOS disability score was also significantly larger for TAR (36.7 ± 24.3) and AAA (40.5 ± 26.4) compared with OAA (26.0 ± 26.2; p = 0.0013). However, the greater improvements did not meet the minimal clinically important difference. The TAR group underwent more reoperations than AAA and OAA groups (p < 0.0001). Revision rates were similar for all 3 groups (p = 0.262). CONCLUSIONS AAA and OAA resulted in comparable clinical outcomes to TAR in patients with non-deformed, COFAS Type-1 end-stage ankle arthritis. The rate of component revision in patients who underwent TAR was similar to the rate of revision for patients who underwent AAA or OAA; however, TAR patients underwent a greater number of additional procedures. Overall, AAA and TAR involving the HINTEGRA prosthesis were not significantly different surgical options in terms of short-term outcomes; patients should be counseled regarding higher reoperation rates for TAR. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrea N Veljkovic
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Centre for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Mark A Glazebrook
- Division of Orthopedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Peter J Dryden
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Orthopaedic Surgery, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Murray J Penner
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Centre for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kevin J Wing
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Centre for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alastair S E Younger
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Centre for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
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Glazebrook M, Younger ASE, Daniels TR, Singh D, Blundell C, de Vries G, Le ILD, Nielsen D, Pedersen ME, Sakellariou A, Solan M, Wansbrough G, Baumhauer JF. Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: A comparison of operative and recovery time. Foot Ankle Surg 2018; 24:440-447. [PMID: 29409199 DOI: 10.1016/j.fas.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/02/2017] [Accepted: 05/11/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND First metatarsophalangeal joint (MTPJ1) hemiarthroplasty using a novel synthetic cartilage implant was as effective and safe as MTPJ1 arthrodesis in a randomized clinical trial. We retrospectively evaluated operative time and recovery period for implant hemiarthroplasty (n=152) and MTPJ1 arthrodesis (n=50). METHODS Perioperative data were assessed for operative and anaesthesia times. Recovery and return to function were prospectively assessed with the Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) subscales and SF-36 Physical Functioning (PF) subscore. RESULTS Mean operative time for hemiarthroplasty was 35±12.3min and 58±21.5min for arthrodesis (p<0.001). Anaesthesia duration was 28min shorter with hemiarthroplasty (p<0.001). At weeks 2 and 6 postoperative, hemiarthroplasty patients demonstrated clinically and statistically significantly higher FAAM Sport, FAAM ADL, and SF-36 PF subscores versus arthrodesis patients. CONCLUSION MTPJ1 hemiarthroplasty with a synthetic cartilage implant took less operative time and resulted in faster recovery than arthrodesis. LEVEL OF EVIDENCE III, Retrospective case control study.
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Affiliation(s)
- Mark Glazebrook
- Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax Infirmary (Room 4867), 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
| | - Alastair S E Younger
- Department of Orthopaedics, University of British Columbia, 560-1144 Burrard Street, Vancouver, British Columbia V6Z 2A5, Canada.
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital, 55 Queen St. E, Suite 800, Toronto, ON M5C 1R6, Canada.
| | - Dishan Singh
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA74LP, United Kingdom.
| | - Chris Blundell
- Northern General Hospital, Herries Road, Sheffield S7 5AU, United Kingdom.
| | - Gwyneth de Vries
- Dalhousie University and Memorial University of Newfoundland, 440 King Street, Suite 405, Fredericton, NB E3B 5H8, Canada.
| | - Ian L D Le
- University of Calgary and LifeMark Health Centre, 2225 Macleod Trail South, Calgary, Alberta T2G 5B6, Canada.
| | - Dominic Nielsen
- St. George's Hospital, St. James Wing, 5th Floor, Blackshaw Road, London SW170QT, United Kingdom.
| | - M Elizabeth Pedersen
- University of Alberta, Orthopedic Research, 8440-112 Street, 6-110 Clinical Sciences Bldg., Edmonton, Alberta T6G 2B7, Canada.
| | - Anthony Sakellariou
- Frimley Park Hospital, Portsmouth Road, Frimley, Camberley GU167UJ, United Kingdom.
| | - Matthew Solan
- Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU27XX, United Kingdom.
| | - Guy Wansbrough
- Torbay Hospital, Lawes Bridge, Torquay, Devon TQ27AA, United Kingdom.
| | - Judith F Baumhauer
- Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
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O’Connor K, Klein S, Ebeling P, Flemister AS, Phisitkul P. Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418790003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Sandra Klein
- Washington University in St Louis, Chesterfield, MO, USA
| | - Patrick Ebeling
- Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA
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Boylan MR, Riesgo AM, Paulino CB, Sheskier SC. Does Total Ankle Arthroplasty Belong in the Comprehensive Care for Joint Replacement? J Foot Ankle Surg 2018; 57:69-73. [PMID: 29268905 DOI: 10.1053/j.jfas.2017.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Indexed: 02/03/2023]
Abstract
The Comprehensive Care for Joint Replacement (CJR) model seeks to lower costs and improve quality for primary lower extremity joint replacements. This includes total ankle arthroplasty (TAA), which is performed far less frequently than total hip (THA) and knee (TKA) arthroplasty. We used the SPARCS database to identify 537 TAA and 239,053 elective primary THA or TKA procedures from 2009 to 2014, excluding hip fractures. Compared with THA and TKA, TAA had a shorter mean length of stay (2.2 versus 3.2 days), greater mean cost ($20,817 versus $17,613), lower rate of disposition to nursing and rehabilitation facilities (17% versus 52%), and lower rate of 90-day readmission (4.9% versus 5.8%). In multivariable-adjusted regression models of TAA versus THA and TKA, length of stay was 30% shorter (p < .001), costs were 14% greater (p < .001), and risk of disposition to nursing and rehabilitation facilities was 86% lower (p < .001), with no significant difference in 90-day readmission (p = .957). Patients undergoing TAA had different patterns of short-term resource usage compared with patients undergoing THA and TKA, most notably higher short-term costs. The economic viability of TAA is threatened by alternative payment models that reimburse hospitals for TAA at the same rate as THA and TKA.
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Affiliation(s)
- Matthew R Boylan
- Resident in Orthopaedic Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
| | - Aldo M Riesgo
- Resident in Orthopaedic Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Carl B Paulino
- Associate Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY
| | - Steven C Sheskier
- Associate Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
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Gagné OJ, Veljkovic A, Glazebrook M, Daniels TR, Penner MJ, Wing KJ, Younger ASE. Prospective Cohort Study on the Employment Status of Working Age Patients After Recovery From Ankle Arthritis Surgery. Foot Ankle Int 2018; 39:657-663. [PMID: 29506397 DOI: 10.1177/1071100718757722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND People who are affected by end-stage ankle arthritis are as disabled as those suffering from arthritis in other main articulations of the lower extremity. Once these patients become unable to perform their job duties, they leave the workforce and require financial aid from government agencies, which represents a considerable economic burden. Regardless of whether arthrodesis or arthroplasty is performed, we hypothesized that patients younger than 55 years at the time of surgery should be able to return to work within 2 years and require less social assistance. METHODS Patients from 2002 to 2014 included in the nationwide prospective Ankle Reconstruction Database treated for end-stage ankle arthritis with a total ankle replacement or an ankle arthrodesis and younger than 55 years at the time of surgery were included. This study used a standard preoperative survey (AAOS, SF-36) along with the same survey filled by patients in intervals up to 2 years postoperatively. Their employment status was determined at each time point. Participation in third-party wage assistance programs was recorded. This cohort had 194 patients with an average age of 47.0 ± 7.2 years and was balanced in terms of sex (104 female) and side (94 left). RESULTS The employment rate prior to surgery was 56%, which increased to 62% at the 2-year postoperative mark. With regards to worker's compensation, disability, and social security, 20% of patients left all subsidized programs whereas 4% entered at least 1 which is significant (P < .05). CONCLUSION The 2-year follow-up after tibiotalar arthrodesis/arthroplasty in patients younger than 55 years showed that significantly more people were able to leave subsidized work assistance programs than enroll in them. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Oliver J Gagné
- 1 University of British Columbia Orthopedics, Vancouver, BC, Canada
| | - Andrea Veljkovic
- 2 Saint-Paul's Hospital Department of Orthopedics, Vancouver, BC, Canada
| | - Mark Glazebrook
- 3 Queen Elizabeth Health Science Center, Halifax, NS, Canada
| | | | | | - Kevin J Wing
- 2 Saint-Paul's Hospital Department of Orthopedics, Vancouver, BC, Canada
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Reddy S, Koenig L, Demiralp B, Nguyen JT, Zhang Q. Assessing the Utilization of Total Ankle Replacement in the United States. Foot Ankle Int 2017; 38:641-649. [PMID: 28552044 DOI: 10.1177/1071100717695111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAR) has been shown to be a cost-effective procedure relative to conservative management and ankle arthrodesis. Although its use has grown considerably over the last 2 decades, it is less common than arthrodesis. The purpose of this investigation was to analyze the cost and utilization of TAR across hospitals. METHODS Our analytical sample consisted of Medicare claims data from 2011 and 2012 for Inpatient Prospective Payment System hospitals. Outcome variables of interest were the likelihood of a hospital performing TAR, the volume of TAR cases, TAR hospital costs, and hospital profit margins. Data from the 2010 Cost Report and Medicare inpatient claims were utilized to compute average margins for TAR cases and overall hospital margins. TAR cost was calculated based on the all payer cost-to-charge ratio for each hospital in the Cost Report. Nationwide Inpatient Sample data were used to generate descriptive statistics on all TAR patients across payers. RESULTS Medicare participants accounted for 47.5% of the overall population of TAR patients. Average implant cost was $13 034, accounting for approximately 70% of the total all-payer cost. Approximately, one-third of hospitals were profitable with respect to primary TAR. Profitable hospitals had lower total costs and higher payments leading to a difference in profit of approximately $11 000 from TAR surgeries between profitable and nonprofitable hospitals. No difference was noted with respect to length of stay or number of cases performed between profitable and nonprofitable hospitals. TAR surgeries were more likely to take place in large and major teaching hospitals. Among hospitals performing at least 1 TAR, the margin on TAR cases was positively associated with the total number of TARs performed by a hospital. CONCLUSION There is an overall significant financial burden associated with performing TAR with many health systems failing to demonstrate profitability despite its increased utilization. While additional factors such as improved patient outcomes may be driving utilization of TAR, financial barriers may exist that can affect utilization of TAR across health systems. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
| | - Lane Koenig
- 2 KNG Health Consulting, LLC, Rockville, MD, USA
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18
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Abstract
Reoperation rates are higher in total ankle arthroplasties (TAAs) compared with ankle arthrodesis. Infection rates for primary TAAs are 1.4% to 2.4%. The survival rate of TAA is approximately 75% to 90% at 10 years. Arc of motion is maintained with TAAs compared with ankle arthrodesis. Ankle arthrodesis increases arc of motion through the talonavicular joint. Several factors are strong reasons to favor ankle fusion rather than TAA. TAA and ankle arthrodesis are effective treatments of end-stage ankle arthritis but the choice must be tailored to individual patients.
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Affiliation(s)
- Joel Morash
- QE2 Health Science Center, Halifax Infirmary (Room 4867), 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
| | - David M Walton
- Beaumont Orthopedics, Michigan Orthopedic Institute, Royal Oak, MI 21601, USA
| | - Mark Glazebrook
- QE2 Health Science Center, Halifax Infirmary (Room 4867), 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
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