Background/Purpose: To assess the time-trends in utilization, clinical characteristics and outcomes of patients undergoing total ankle arthroplasty (TAA) in the U.S.

Methods: We used the Nationwide Inpatient Sample (NIS) data from 1998 to 2010 to examine time-trends in TAA. Rates were calculated for the U.S. population. We used the Cochran Armitage test for trend to test for trend across the years.   We compared the first and the last period for trends using, ANOVA and chi-squared test as appropriately.

Results:   TAA utilization rate increased from 0.12 per 100,000 in 1998 to 0.84 per 100,000 in 2010. The Cochran Armitage test for trend across years yielded a significant p-value of <0.0001. In females and males, the rate increased from 0.14 to 0.88 per 100,000 (p<0.0001 for time-trend) and from 0.11 to 0.81 per 100,000 (p<0.0001 for time-trend), respectively. Compared to the 1998-99, significantly fewer patients <50 years (37% fewer) and more patients ≥80 years (85% higher) in 2009-10 underwent TAA (p <0.0001).  Compared to 1998-99, RA was less frequently the underlying diagnosis (55% reduction) and a greater proportion of patients had Deyo-Charlson index of 2 or more (33% more) in 2009-10. Comparing 1998-99 to 2009-10, we noted a slight decrease in the length of stay from 2.7 to 2.5 days (17% reduction), slight increase in the proportion of patients being discharged to inpatient facility from 12.9% to 14.1% (12% increase) and no change in mortality, 0.13% to 0.12% (9% decrease). 

Conclusion: The utilization rate of TAA is rapidly increasing in the U.S. Underlying diagnosis and medical comorbidity has changed over time that can impact the type and frequency of complications after TAA.  Further studies are needed to assess how the outcomes and complications of TAA have evolved over time.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/time-trends-in-total-ankle-arthroplasty-a-study-of-the-u-s-national-inpatient-sample/