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In end-stage ankle arthritis, joint cartilage has worn away and pain occurs as bone rubs against bone. Although less common than arthritis of the hip or knee, the pain and disability of end-stage ankle arthritis affect patients as much as severely disabling physical conditions such as end-stage hip arthritis, end-stage kidney disease, and congestive heart failure.

End-stage arthritis of the ankle joint affects more than 50,000 people in the US. In up to 80% of cases, the condition is posttraumatic,with the 3 most common traumatic causes being rotational ankle fractures (37%), recurrent ankle instability (15%), and single sprain with continued pain (14%).

When conservative treatments do not provide enough relief, surgical options should be considered. Ankle replacement, or ankle arthroplasty, is a surgical procedure to replace the damaged articular surfaces of the human ankle joint with prosthetic components.

This procedure is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement compared to arthrodesis.

The popularity and utilization of total ankle arthroplasty (TAA) as treatment for ankle arthritis has increased exponentially from 1998 to 2012.

Overall the outcomes have improved for TAA with the introduction of new-generation implants and this has increased the focus on optimizing other variables affecting outcomes for TAA. However, there is little data regarding other variables which affect TAA procedure outcomes

A new study was conducted in order to improve this current limited information, “The Impact of Hospital Size and Teaching Status on Outcomes Following Total Ankle Arthroplasty,” was published online in The Journal of Foot & Ankle Surgery last month. The purpose of this study was to examine the effects of hospital characteristics and teaching status on outcomes for total ankle arthroplasty (TAA).

The Nationwide Inpatient Sample (NIS) database was queried from 2002-2012 using the ICD-9 procedure code for TAA. A total weighted national estimate of 16,621 discharges for patients undergoing TAA was reported over the 10-year period.

The primary outcomes evaluated included: in-hospital mortality, length of stay, total hospital charges, discharge disposition, perioperative complications, and patient demographics.

Analyses were carried out based on hospital size: small, medium, and large; and teaching status: rural non-teaching, urban non-teaching, and urban teaching.

The analysis showed that the size of a hospital and teaching status produced better overall ankle arthroplasty patient outcomes. Rural, non-teaching hospitals had higher odds of perioperative complications. There were also significant differences in length of stay and total charges when comparing hospital sizes.

Overall, there is no increased risk of mortality after TAA regardless of hospital size or setting.

Vani J. Sabesan, M.D., FAAOS, FAOA, a shoulder and elbow/sports medicine specialist in Florida and his colleagues wrote in their study, “Our analyses demonstrated important factors affecting cost and resource utilization for total ankle arthroplasty, clearly additional work is needed to optimize this relationship, especially in the upcoming bundled payment.”