A National Comparison of Total Ankle Replacement Versus Arthrodesis. Is There a Paradigm Shift?

Transcription

1 A National Comparison of Total Ankle Replacement Versus Arthrodesis. Is There a Paradigm Shift? Andrew F. Sabour, BS R. Kiran Alluri, MD Eric W. Tan, MD Keck School of Medicine of USC Los Angeles, CA

2 Disclosures I (and/or my coauthors) have no conflicts to disclose. A National Comparison of Total Ankle Replacement Versus Arthrodesis. Is There a Paradigm Shift? Andrew F. Sabour, BS R. Kiran Alluri, MD Eric W. Tan, MD Refer to the AAOS Disclosure Program website. We have no disclosures related to this presentation.

3 Background Total ankle replacement (TAR) and tibiotalar arthrodesis (TTA) are both utilized in the surgical management of ankle osteoarthritis. Surgical techniques and instrumentation have improved and indications for TAR have progressively broadened, leading to a decline in performed TTAs. Procedure preference can vary widely between physicians.

4 Purpose (1) To identify the change in national incidence between TAR and TTA over time. (2) To identify any diagnostic, preoperative, patient, or hospital variables that may lead to a greater preference in either TAR or TTA.

5 Methods 67,974 Treated with TTA or TAR 67,327 Unique procedures 50,156 Age > 50yo 35,096 TTA 15,060 TAR The National Inpatient Sample (NIS) was used for patient data between Procedure filter: Ankle arthrodesis (ICD ) Total ankle replacement (ICD ) Exclusion criteria: Shared arthrodesis & replacement procedures Revision of joint replacement of lower extremity (ICD ) Patients < 50 years of age

6 Methods Univariate analysis compared patient demographics, pre-operative comorbidities, inpatient variables, and hospital variables between success and failure groups. Student s t-test compared continuous variables. Fisher s exact test or Chi-square analysis compared categorical variables. Pre-operative comorbidities with a p-value <0.05 and prevalence >0.5% were included in a logistic regression for multivariate analysis.

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8 Results Patient variables Arthrodesis (TTA) N = 35,096 Replacement (TAR) N = 15,060 P-value Age 63.7 ± ± 8.68 <0.001 Sex (Female) 17,100 (48.9%) 7,520 (50.0%) Total comorbidities 2.17 ± ± 1.31 <0.001 Anemia 3,950 (11.3%) 778 (5.17%) <0.001 Renal failure 3,110 (8.86%) 424 (2.82%) <0.001 Length of stay 3.43 ± ± 1.41 <0.001 Teaching hospitals 15,100 (58.69%) 4,530 (54.78%) 0.011

9 Temporal analysis demonstrated a significant 15% increase every 3 years in TAR performed from 2007 (14%) to 2013 (45%)

10 Results PRIMARY Diagnosis % TAR ( 07) % TAR ( 13) Increased Odds of Receiving a TAR in 2013 versus 2007 P-value Post-traumatic OA 9.3% 55.5% 12.14x <0.001 Primary OA 25.6% 62.9% 4.93x <0.001 Rheumatoid arthritis 25.5% 51.4% 3.12x <0.001 COMORBID Diagnosis % TAR ( 07) % TAR ( 13) Increased Odds P-value of Receiving a TAR in 2013 versus 2007 DM + HTN + CAD 12.6% 40.3% 4.66x <0.001

11 Conclusions Surgeons are performing TAR with greater frequency. Temporal analysis demonstrated a significant 15% increase every 3 years in TAR performed from 2007 (14%) to 2013 (45%) The largest change from TTA to TAR was with posttraumatic osteoarthritis. As technology has advanced and surgeons have become more facile with the technique, patients with specific comorbidities are undergoing TAR at a significantly higher annual incidence.

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