Projections for Total Ankle Arthroplasty based upon the National Inpatient Sample

Category: Ankle Arthritis Introduction/Purpose: The utilization of total ankle arthroplasty (TAA) has increased significantly over the past decade. While projections for hip and knee arthroplasty show an exponential increase in demand, there remains a paucity of literature on the projected demand for TAA. Outcomes for TAA show promising results at 10 year follow up and, as a result, the demand for TAA will likely see a significant increase over the next few decades. The purpose of this study is to assess the current trends and future demand of TAA utilization. Methods: National Inpatient Sample (NIS) data from 1997-2014 was used to identify trends in the utilization of TAA. United States Census Bureau data from 1997-2014 was used to identify historical population data and future population estimates. A linear regression model was created using Mathematica v11.3 to project future demand for total ankle arthroplasty. The data was stratified to show past and future trends based on gender and age. Results: The overall utilization rate of TAA increased from 232 procedures in 1997 to 4435 procedures in 2014. Based on our model, the overall demand for TAA is expected to increase by 174 percent to 12,161 procedures by 2045. Stratified by age groups, the number of procedures is predicted to increase by 69% in ages 18-44, 177% in ages 45-64, and 287% in ages 65-84 by 2045. Stratified by gender, males are projected to undergo 7,070 procedures and females are projected to undergo 6,114 procedures in 2045. Conclusion: Improvements in TAA techniques and implants are leading to better long term clinical outcomes following TAA. Based on our projection model, there is going to be a significant increase in demand for TAA by 2045

A 27-year Meta-analysis of Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty is an alternative to ankle arthrodesis for the treatment of end-stage arthritis while maintaining greater ankle motion and functionality. Early generation implants had unacceptably high complication rates. However, increasing surgical experience and newer third-generation designs have the potential to offer better outcomes. A previous systematic review reported results from studies published between 1990 and 2005, focusing on second-generation implants. We performed a systematic review of the literature addressing the intermediate-long-term outcomes of interest in total ankle arthroplasty studies published since 2006, and we compared our findings to those from earlier generation implants. Methods: A comprehensive search of MEDLINE for all articles published from 3/25/2006 to 2/1/2017 was conducted with a minimum two-year follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed. The analysis focused on third-generation ankle implants. Results: The previous systematic review identified 10 studies (n=852), whereas we identified 40 studies (n=4835). The prior study showed a five and ten-year survival rate of 78% and 77%, respectively; respective rates were 86% (p=0.001) and 76% (p=0.53) in ours and similar to the previous study. The revision rate following TAR was 7% in the earlier review (loosening/subsidence, 28%). In ours, the revision rate following TAR was 9.6% (p=0.10) (component loosening, 37%); 3.4% (p=0.02) of ankles were converted to arthrodesis. The mean post-operative Ankle-Hindfoot score was 78.2 points in the prior review and 80.1 (p=0.20) points for ours. There is significant (p<0.0001) heterogeneity (I2=92.94%) between the studies; a meta-analysis of proportions showed that 81.6%of subjects had good outcomes while 46.6% had an excellent outcome. Conclusion: Based on these findings, the outcomes for third-generation total ankle arthroplasty have no significant differences in survival rates when compared to second-generation implants. However, functional scores, range of motion, and overall patient outcomes were significantly higher in the third-generation implants. However, data from early generation studies were sparse in comparison, so direct comparative studies are needed to strengthen this conclusion