Abstract
BackgroundTotal ankle arthroplasty (TAA) has become increasingly popular worldwide as an alternative to ankle arthrodesis for surgical treatment of end-stage ankle arthritis. The aim of this epidemiological study, using a national inpatient database in Japan, was to describe the volume, utilization, patient characteristics, and temporal trends regarding these procedures in Japan, and to identify the risk factors associated with perioperative adverse events in TAA.MethodsThis was a population-based, retrospective cohort study. We retrospectively identified 2775 patients in the Diagnosis Procedure Combination database who underwent ankle arthrodesis or TAA for ankle arthritis at 559 hospitals in Japan from 2007 to 2013. Information on sex, age, main diagnosis, use of blood transfusion, duration of anesthesia, length of hospital stay, in-hospital mortality, hospitalization costs, additional procedures after primary surgery, and use of negative pressure wound therapy was extracted. Multivariable logistic regression analysis was performed to analyze the effect of various factors on the incidence of perioperative adverse events in TAA, including additional procedure during hospitalization, negative pressure wound therapy, blood transfusion, and in-hospital death.ResultsWe identified 465 patients who underwent TAA and 2310 patients who underwent ankle arthrodesis. There was no apparent increase in the proportion of TAAs performed during the survey period. Patients undergoing TAA tended to be older, female, and have rheumatoid arthritis compared with those undergoing ankle arthrodesis. Patients undergoing TAA had shorter length of stay, higher hospitalization costs, and more blood transfusions compared with those undergoing ankle arthrodesis. Lower hospital volume and shorter anesthesia time were associated with higher rates of adverse events after TAA.ConclusionsDespite an increase in the popularity of TAA internationally, the number of TAAs performed remains low in Japan. Lower hospital volume and anesthesia time were associated with higher rates of perioperative adverse events after TAA.Level of evidenceIV, Cross-sectional study
Highlights
Total ankle arthroplasty (TAA) has become increasingly popular worldwide as an alternative to ankle arthrodesis for surgical treatment of end-stage ankle arthritis
Forty years have passed since the introduction of the first-generation total ankle arthroplasty (TAA), which ended in failure because of high rates of aseptic loosening and pain
Based on improved clinical outcomes, TAA has become increasingly popular as an alternative to arthrodesis, which has long been the gold standard for treating end-stage ankle arthritis
Summary
Total ankle arthroplasty (TAA) has become increasingly popular worldwide as an alternative to ankle arthrodesis for surgical treatment of end-stage ankle arthritis The aim of this epidemiological study, using a national inpatient database in Japan, was to describe the volume, utilization, patient characteristics, and temporal trends regarding these procedures in Japan, and to identify the risk factors associated with perioperative adverse events in TAA. A previous report using the United States Nationwide Inpatient Sample data contained data from five to eight million hospital stays and discharges from > 1,000 hospitals sampled to approximate a 20 % stratified sample of United States community hospitals This sample showed an approximately 6-fold increase in TAA utilization in the previous decade, from 0.13 per 100,000 population in 1998 to 0.84 per 100,000 population in 2010 [2]. Joint registry data from New Zealand demonstrated an approximately 4-fold increase in TAA from 26 arthroplasties in 2003 to 113 arthroplasties in 2013 [6]
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