Number Of Total Ankle Arthroplasties Research Articles

Effects of Travel Distance on Complications and Outcomes in Total Ankle Arthroplasty.

Owing to the last decade's increase in the number of total ankle arthroplasty (TAA) procedures performed annually, there is a concern that the disproportionate distribution of orthopaedic surgeons who regularly perform TAA may impact complications and/or patient satisfaction. This study examines patient-reported outcomes and complications in TAA patients who had to travel for surgery compared to those treated locally. This is a single-center retrospective review of 160 patients undergoing primary TAA between January 2016 and December 2018, with mean age 65 (range: 59-71) years, mean body mass index (BMI) 28.7 kg/m2, 69 (43.1%) females, and mean 1.5 (SD = 0.51) years follow-up. Patients were grouped by distance traveled (<50 miles [n = 89] versus >50 miles traveled [n = 71]). There were no significant differences in rate or type of postoperative complications between the <50 mile group (16.9%) and the >50 mile group (22.5%) (P = .277). Similarly, there were no significant difference in postoperative PROMIS scores between the groups (P = .858). Given uneven distribution of high-volume surgeons performing TAA, this is important for patients who are deciding where to have their TAA surgery and for surgeons on how to counsel patients regarding risks when traveling longer distances for TAA care.Levels of Evidence: Level III: Retrospective Cohort Study.

Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis.

The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis's survival.

Tibiotalocalcaneal arthrodesis with femoral head allograft, external fixator provisional compression, and locking plate fixation after failed total ankle arthroplasty

The number of total ankle arthroplasties has increased in recent years with the improvement of implants and advanced attempts to maintain ankle movement. However, this technique presents complications, such as aseptic loosening and infection, requiring revision surgery. In this scenario, conversion by tibiotalar or tibiotalocalcaneal arthrodesis is highly accepted and can be performed with external fixators, intramedullary rods, screws, or locking plates. This article shows the resolution of a case of aseptic loosening tibiotalocalcaneal arthrodesis fixed with a locking plate associated with bone allograft. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Outcomes of Salvage Procedures for Failed Total Ankle Arthroplasty.

The number of total ankle arthroplasty (TAA) procedures increased rapidly in the last years and so have its complications. The main pillars in treating failed TAA are revision total ankle arthroplasty (RTAA), revision total ankle arthrodesis (RAA), or revision tibiotalocalcaneal fusion (RTTC). To evaluate these options, we compared clinical, radiologic, and patient-reported outcomes. A single-center, retrospective review of 111 cases of revision procedures of failed TAA from 2006 to 2020 was performed. Patients undergoing polyethylene exchange and revision of one metallic component were excluded. Demographic data, failure, and survival rates were analyzed. The European Foot and Ankle Society (EFAS) score and radiographic changes in the subtalar joint were evaluated. The average follow-up was 67.89 ± 40.51 months. One hundred eleven patients underwent removal of TAA. The procedures included 40 revisions of both metallic components, 46 revision total ankle arthrodesis and 25 revision tibiotalocalcaneal fusion. The overall failure rate in the cohort was 5.41% (6/111). The failure rate after RAA was 4.35 times higher than that of RTAA, whereas RTTC did not show failures. RTAA and RTTC lead to a 1-year and 5-year survival rate of 100%. RAA resulted in a 1-year survival rate of 90% and a 5-year survival rate of 85%. The mean EFAS score in the cohort was 12.02 ± 5.83. Analysis of the EFAS score showed that RTTC provided the most reliable pain reduction, and RTAA achieved the best gait pattern. RAA resulted in poorer clinical results. Subtalar joint degeneration occurred significantly less in the RTAA group (P = .01). This retrospective study suggests lower failure rates, increased short-term survival and a better clinical outcomes of revision arthroplasty and tibiotalocalcaneal fusion than ankle arthrodesis. Revision arthroplasty is a promising solution in treating failed total ankle arthroplasty considering lower rate of subsequent adjacent joint degeneration. Level III, non-randomized observational study.

Midterm Outcomes of the INBONETM II Total Ankle Arthroplasty

As the number of total ankle arthroplasties (TAA) performed continues to increase, understanding midterm outcomes can guide both implant selection and preoperative patient counseling. The purpose of this study was to investigate midterm results including the survival rate and reasons for revision for the INBONETM II TAA. Patients undergoing a primary TAA with the study implant and minimum of 4.6 years postoperative follow-up were reviewed from a prospectively collected database. The primary outcome was implant survival. Secondary outcomes included coronal plane radiographic alignment, evaluation for cysts and osteolysis, and failure mode when applicable. Patients were eligible for inclusion in this study if they had a minimum of 4.6-year follow-up TAA with the study implant. Eighty-five TAAs in 83 patients were eligible for inclusion; 75 TAA in 73 patients were included in the study. The mean duration of follow up was 6.2 ± 0.9 years (range 4.7-8.1 years). Thirty-six percent of the TAAs had a preoperative coronal plane deformity of at least 10°, and 12% of the TAAs had at least 20°. There were 6 (8%) implant failures that occurred at a mean 2.0 ± 1.4 years postoperatively. Eighty-one percent of the TAAs had no reoperation events in the follow-up period. Midterm outcomes at a minimum of 4.6 years postoperatively in patients undergoing a TAA using this implant demonstrates acceptable implant survival, an approximately 20% reoperation rate, and maintenance of coronal plane alignment.

Early Revisions, Reoperation, and Survivorship of the Exactech Vantage Fixed-Bearing Total Ankle Arthroplasty Implant

Category: Ankle Arthritis; Ankle Introduction/Purpose: In the last decade, there has been a rapid increase in the number of total ankle arthroplasties (TAA) performed annually. In addition, multiple novel TAA implants have been introduced onto the market. The Exactech Vantage TAA is a fixed-bearing implant that has been in use since 2016. The tibial component is low-profile with vertically oriented pegs and a cage, while the talus is curved with an anterior flange to prevent subsidence. This study sought to describe the early experience with the Vantage TAA, including reoperation, revision, and radiographic outcomes. Methods: This is a single-center retrospective review of patients who underwent primary TAA using the Vantage Total Ankle (Exactech, Gainesville, FL). Concomitant procedures at the time of index surgery were recorded. Five surgeons contributed patients. Demographics, clinical and operative data, postoperative complications, reoperations, and revisions were collected. Revisions and reoperations were classified by standardized criteria. Radiographs were reviewed by a fellowship-trained foot and ankle surgeon to assess for alignment and peri-implant complications. There were 190 patients included in the study who were all minimum 2 years post-TAR, with mean clinical follow-up of 1.8 years (range: 1-48 months), and mean age 63.3 +- 9.4 years. Ankle arthritis etiologies were 45% post-traumatic (fracture history), 33% instability, 12% primary osteoarthritis, 5% flatfoot, 2% inflammatory arthritis, and 4% other. Thirteen patients (7%) had hindfoot fusion performed previously or at the time of index surgery. Concomitant procedures are shown in Table. Results: Overall implant survivorship was 95.3%. There were 5 intraoperative complications: 4 anterolateral tibial fractures and 1 medial malleolar fracture, all treated with internal fixation at the time of surgery with no further complications. Nine patients (4.8%) underwent revision: 7/9 for tibial loosening, 1 for talar loosening, and 1 for periprosthetic joint infection. Eleven patients (5.8%) underwent reoperation: open gutter debridement (5); irrigation and debridement for superficial infection (4); and bone grafting for cysts (2). Radiographically, preoperative coronal alignment was mean 10.1°, with 87 (49%) ankles with &gt;10° deformity. Three patients had tibial component subsidence that was stable, 3 had stable radiolucency around the tibial component, and 1 had valgus failure through the ankle joint. Nineteen had asymptomatic peri-implant cysts; 16/19 were at the tibia. Conclusion: Short-term results of the Vantage TAA implant demonstrate survivorship of 95.3% at 2 years, which is comparable to similar studies of low-profile, non-stemmed implants. Asymptomatic radiographic complications were primarily cystic changes at the tibial component. Revisions occurred primarily due to loosening of the tibial component. Additional follow-up and multi- institutional support are warranted to further quantify survivorship and risk factors.

A Propensity Score Matched Analysis Comparing Outpatient and Short-Stay Hospitalization to Standard Inpatient Hospitalization Following Total Ankle Arthroplasty

Category:AnkleIntroduction/Purpose:The number of total ankle arthroplasties (TAAs) performed annually has continued to increase over the last two decades. Given the current challenges of healthcare cost-control, the trend towards minimizing hospitalization and length of stay (LOS) after various procedures, including joint replacement, has become an area of interest. Currently, there are no large sample, propensity score matched analyses to assess the safety of ‘short-stay’ versus standard inpatient hospitalization following TAA.Methods:The American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) was used to identify 1,141 patients who underwent primary and revision TAA between 2007 and 2017. Propensity score matching was used to compare the risk of 30-day unplanned readmission, reoperation, mortality, discharge destination, and several medical and surgical complications in patients with outpatient or short-stay inpatient hospitalization (LOS <= 1 day) versus standard inpatient hospitalization (LOS > 1 day). Patients were matched in a 1:1 ratio based on several factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and several comorbidities (diabetes, smoking, COPD, congestive heart failure, hypertension, dialysis, and chronic steroid use). The incidence of various 30-day complications were compared between the two propensity score matched groups to assess for any differences in short-term outcomes after controlling for confounding risk factors.Results:A total of 892 patients were included in the propensity-score matched analysis, with 446 patients per group. The shorter LOS group had a significantly lower rate of medical complications (0.2% vs. 2.8%, p = 0.004) and non-home discharge (1.3% vs.12.1%, <0.001). Additionally, the shorter LOS group had lower rates of unplanned readmission (0.4% vs. 1.1%, p = 0.256), reoperation (0.2% vs. 0.4%, p = 0.564), return to the OR (0.2% vs. 0.9%, p = 0.179), and surgical complications (0.4% vs. 2.0%, p = 0.057), although these results were not statistically significant.Conclusion:Propensity score matched comparative analysis demonstrated that outpatient and short-stay inpatient hospitalization can be just as safe as standard inpatient hospitalization after TAA. Length of stay should be dictated by the overall risk of complication. Outpatient or short-stay TAA should be considered for patients with low risk of short-term complications.

Discharge to a Non-Home Destination Following Total Ankle Arthroplasty (TAA): An Analysis of the ACS-NSQIP Database

Despite an increasing trend in the number of total ankle arthroplasties (TAAs) being done globally, current evidence remains limited with regards to factors influencing a non-home discharge to a facility following the procedure. The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 27702 for patients undergoing TAA. Discharge to a destination was categorized into home and non-home. Multivariate analysis using logistic regression models were used to evaluate independent risk factors associated with non-home discharge disposition. As a secondary objective, we also evaluated risk factors associated with a prolonged length of stay (LOS) >2 days. A total of 722 TAAs were retrieved for final analysis. A total of 68 (9.4%) patients experienced a non-home discharge following the surgery. Independent factors for a non-home discharge were a LOS >2 days (odds ratio [OR] 10.51), age ≥65 years (OR 4.52), female (OR 2.90), hypertension (OR 2.63), and American Society of Anesthesiologists >II (OR 2.01). A total of 174 (24.1%) patients stayed in the hospital for more than 2 days. Significant risk factors for LOS >2 days were age ≥65 years (OR 1.62), female (OR 1.53), operative time >150 minutes (OR 1.91), and an inpatient admission status (OR 4.74). With limited literature revolving around outcomes following TAA, the current study identifies significant predictors associated with a non-home discharge. Providers should consider preoperatively risk-stratifying and expediting discharge in these patients to reduce the costs associated with a prolonged hospital length of stay.

Arthrodesis of the Foot or Ankle in Adult Patients with Congenital Clubfoot.

BackgroundAlthough clubfoot that was corrected in childhood rarely recurs in adulthood, persistent deformities or arthritic pain may require further treatment during adulthood. Little evidence exists on the operative procedures utilized in adult clubfoot patients, who were previously treated for congenital clubfoot in childhood, for residual or recurrent deformity or pain.ObjectiveThe objective of this study is to characterize the types and frequencies of procedures utilized in adult clubfoot patients, who were previously treated for congenital clubfoot in childhood.MethodsA two-pronged approach was employed to describe the operative procedures used in adult clubfoot patients. First, a literature review of all reported cases of operative treatment in adult clubfoot patients who were previously treated in childhood was performed. Second, an analysis of the operative treatments used in adult patients with a diagnosis of congenital clubfoot was conducted using a large, administrative claims database.ResultsIn the literature review, arthrodesis was the most cited operative treatment and reported in four out of the eight studies included. Osteotomies were also reported in the literature. In the database analysis, 94 hindfoot arthrodesis procedures were identified in 73 patients, out of 1,198 adult patients in the database with a diagnosis of congenital clubfoot. Sixty-two patients out of 1,198 adult clubfoot patients received osteotomies. An insufficient number of total ankle arthroplasties were reported for further analysis.ConclusionsOperative treatment in adult clubfoot patients who were treated for congenital clubfoot in childhood includes hindfoot arthrodesis and osteotomy procedures. Total ankle arthroplasty has not been reported in the literature for these patients.

The Use of Tranexamic Acid in Total Ankle Arthroplasty

Category:Ankle ArthritisIntroduction/Purpose:The number of total ankle arthroplasties (TAA) is on the rise. Complications associated with TAA include need for blood transfusion, deep vein thrombosis, hematoma, infection, and wound complications. Tranexamic acid (TXA) use in the total knee and total hip population has been found to decrease the rate of blood transfusion. The rate of infections and blood transfusions in TAA was reported to be 3.2% and 1.3%, respectively. In calcaneal fractures TXA was found to decrease wound complications. Our goal was to evaluate the use of TXA in the TAA population to see if its use decreases blood loss or wound complications.Methods:This is a retrospective review of two patient cohorts operated on by a single surgeon from 2010 to 2016. We compared a group of TAA patients that did not receive TXA versus a subsequent group that received TXA. Patients received 1 g IV TXA before tourniquet was inflated and another 1 g following the release of the tourniquet. Pre-operative hemoglobin and hematocrit levels were compared to postoperative levels. Post-operative complications were compared between the two groups.Results:87 patients were included in the study. 35 patients (40%) received TXA. In patients that received TXA, 18 had postoperative hemoglobin levels available. These patients were compared to a control cohort of 52 patients that did not receive TXA. No significant difference existed between the two groups in gender or age (p=0.9; p=0.7 respectively). Mean estimated blood loss was the same between the two groups. Overall postoperative complications, including wound complications, were higher in the TXA group at 26% vs 12% but this was not statistically significant (p-value = 0.086). The preoperative to postoperative change in hemoglobin/hematocrit levels was not statistically significant between groups (p-value = 0.78). There was one transfusion required in the non-TXA group and no transfusions required in the TXA group (p=0.9).Conclusion:The use of TXA was not found to provide a beneficial effect in total ankle arthroplasty in either decreasing wound complications or blood loss. Given these results, TXA use might not be cost effective in total ankle arthroplasty as opposed to other total joint arthroplasties. Further higher levels studies with increased number of patients are required to further evaluate TXA effectiveness in TAA.

When is it Safe to Drive After Total Ankle Arthroplasty?

With the increase in the number of total ankle arthroplasties (TAA), guidelines on when physicians should begin to consider patients' return to driving are valuable. Further, due to sagittal motion strength, the ankle is the most important mover in braking motions over the knee and hip. (1) Does brake-reaction time return to a safe value within 6 weeks of TAA? (2) Are there factors associated with a delay of return of brake-reaction time to safe values after TAA? After obtaining institutional review board approval for the study, we prospectively recruited 60 patients undergoing right TAA. A large proportion of the patients undergoing TAA during the period were recruited. Patients who had extensive concomitant surgery, such as triple arthrodesis or tibial osteotomy, were excluded from the study. Patients were between 43 and 83 years old (median, 63 years), and 35 (59%) were men. Brake-reaction time was tested at 6 weeks postoperatively and repeated weekly until patients achieved a passing brake-reaction time. A control group of 20 volunteer participants matched for age and sex who did not have right lower-extremity pathology or pain were used to establish a passing brake-reaction time of 0.850 seconds. Patients were given a novel driver-readiness survey to complete; a score of 10 of 15 points or higher was considered a passing score. The following factors were explored for their association with brake-reaction time: age, American Orthopaedic Foot and Ankle Society (AOFAS)-Hindfoot assessment and VAS for pain via a patient-reported survey, and ankle plantarflexion and dorsiflexion via dedicated weightbearing lateral radiographs made with the ankle in maximum plantarflexion and dorsiflexion. At 6 weeks postoperatively, 92% of patients (54 of 59) achieved a passing brake-reaction time and were considered able to drive safely, and the mean brake-reaction time of the patients with a passing brake-reaction time was 0.626 seconds (± 0.111). At 9 weeks, all patients who completed the study achieved a passing brake-reaction time. Patients with a failed brake-reaction time at 6 weeks had greater median VAS scores for pain (3 [interquartile range 2 to 7] versus 1 [IQR 0 to 3]; p = 0.022) and diminished ankle plantarflexion (14° [± 5°] versus 24° [± 10°]; p = 0.037) compared with those with a passing brake-reaction time at that time point. All five patients with a failed brake-reaction time also had a failing score for the driver-readiness survey. More than 90% of patients in this series achieved a safe brake-reaction time within 6 weeks of TAA, and those who did not were more likely to have had more pain and a stiffer ankle. Surgeons might counsel patients with persistent pain and stiffness at 6 weeks to delay driving for an additional 3 weeks, since by 9 weeks after TAA, all patients in this series had a brake-reaction time comparable with patients who had not undergone surgery. Future studies might elucidate what key gaps in knowledge remain and determine a practical way to answer these questions. Level II, therapeutic study.

Patients at Risk for Exceeding CJR Cost Targets After Total Ankle Arthroplasty

The Comprehensive Care for Joint Replacement (CJR) model includes total ankle arthroplasty (TAA), under which a target reimbursement is established. Whether this reimbursement is sufficient to cover average cost remains unknown. We hypothesized that a substantial number of TAAs still exceed cost targets, and that risk factors associated with exceeding the target cost could be identified preoperatively. Two hundred two primary TAAs performed at a single tertiary referral center under the CJR model from June 2013 to May 2017 were retrospectively reviewed. Patient demographics, comorbidities, outcomes, and costs were extracted from the electronic medical record using a validated structured query language (SQL) algorithm. A comparison cohort of 2084 CJR total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases performed during the same period was also reviewed. Twenty TAAs (10%) exceeded the target cost of care, significantly fewer than CJR THAs/TKAs (29%) performed during the same period (P < .0001). These patients did not differ significantly in age, sex, body mass index, number of Elixhauser comorbidities, or the American Society of Anesthesiologists score. The average cost for these patients was $17 338 higher than those who did not exceed the target cost, and they were less likely to be married or have a partner (45% vs 79%, P = .001). Non-Caucasian status also reached significance (P < .0001). Those exceeding the target cost had a significantly longer length of stay (2.6 vs 1.5 days, P < .0001) and were more likely to be discharged to either skilled nursing or a rehabilitation facility (60% vs 1%, P < .0001). Even high-volume TAA centers still exceed target costs in up to 10% of cases, with length of stay, discharge location, and readmissions driving many of these events. Potential risk factors for excess cost include marital/partner status and non-Caucasian ethnicity, but further work is needed to clarify their effects and whether other risk factors exist. Level III, comparative study.

Total Ankle Arthroplasty

Category: Ankle, Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) performed in the United States has risen significantly in recent years. Additionally, utilization of an orthopaedic specialty hospital (OSH) to treat healthy patients undergoing elective surgery is becoming more common. The effect of OSH utilization on post-operative outcomes following TAA has yet to be investigated. The purpose of this study is to compare post-operative outcomes following TAA at an OSH when compared to a matching population of patients undergoing TAA at an academic teaching hospital (ATH). Methods: We identified all primary, atraumatic TAA from January 2014 to December 2014 at the OSH and January 2010 to January 2016 at the ATH. Each OSH patient was manually matched to a corresponding ATH patient by clinical variables (age adjusted Charlson comorbidity index [AACCI], 17 individual comorbidity categories, and body mass index [BMI] and demographic variable (age, gender, and insurance type). Matching was performed in a blinded fashion to outcomes. Outcomes analyzed were LOS, 30-day readmissions, mortality, reoperation, and inpatient rehabilitation utilization. Results: There were 40 TAA patients in each group. OSH and ATH patients were similar in age (66.7 versus 66.8 yo, p=0.95), BMI (both 28.4, p=1.00), age-adjusted Charlson Comorbidity Index (both 3.3, p=1.00), and gender (both 45.0% male, p=1.00). Average LOS for TAA at the OSH was 1.28+/-0.51 compared to 2.03+/-0.89 (p&lt;0.001) at the ATH. No OSH patients were readmitted within 30 days, compared to 2 ATH (5.0%; p=0.15). Two OSH patients (5.0%) and two ATH patients (5.0%; p=1.00) required reoperation. There were no mortalities in either group. No OSH patients utilized inpatient rehabilitation compared to 3 ATH patients (7.5%; p=0.078). When excluding patients utilizing inpatient rehabilitation, patients at the OSH still demonstrated significantly lower LOS (1.28+/-0.51 vs 1.81+/-0.69 days; p&lt;0.001). No OSH patients required transfer. Conclusion: Primary TAA performed at an OSH had significantly shorter LOS when compared to a matched patient treated at an ATH with no significant difference in readmission or reoperation rates. Additionally, patients who had their procedure performed at an OSH utilized inpatient rehabilitation less frequently than those at an ATH. This study suggests that performing TAA at an OSH offers a potential source of significant healthcare savings.

The Regionalization of Total Ankle Arthroplasties and Ankle Fusions in New York State: A 10-Year Comparative Analysis.

Total ankle arthroplasty (TAA) provides an alternative to ankle fusion (AF). The purpose of this study is to (1) determine the extent of TAA regionalization, as well as examine the growth of TAA performed at high-, medium-, and low-volume New York State institutions and (2) compare this regionalization and growth with AF. The New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 737 primary TAA and 7453 AF from 2005 to 2014. The volume of TAA and AF surgery in New York State was mapped according to patient and hospital 3-digit zip code. The number of TAA per year grew 1500% (from 11 to 177) from 2005 to 2014, while there was a 35.6% reduction (from 895 to 576) in yearly AF procedures. TAA recipients were widely distributed throughout the state, while TAA procedures were regionalized to a few select metropolitan centers. AF procedures were performed more uniformly than TAA. The number of TAA has continued to increase at high- (15 to 91) and medium-volume (14 to 67) institutions where it has decreased at low-volume institutions (44 to 19). The increased utilization of TAA is attributed to relatively few high-volume centers located in major metropolitan centers. Level IV: well-designed case-control or cohort studies.

In-Patient Trends and Complications After Total Ankle Arthroplasty in the United States

The number of total ankle arthroplasties (TAAs) performed annually in the United States has increased. The purpose of this study was to evaluate the in-patient demographics, complications, and readmission rates of patients after TAA at academic medical centers in the United States. The University HealthSystems Consortium administrative database was searched for patients who underwent TAA in 2007 to 2011. A descriptive analysis of demographics was performed, followed by a similar analysis of clinical benchmarks, including hospital length of stay, hospital direct cost, in-hospital mortality, and 30-day readmission rates. The study included 2340 adult patients with a mean age of 62 years (47% men and 53% women) who underwent TAA. The majority of patients were Caucasian (2073; 88.5%). Average hospital length of stay was 2.2±1.26 days. Average total direct cost for the hospital was $16,212±7000 per case, with 49.7% of patients having private insurance. In-hospital mortality was less than 1%, and overall complications were 1.4%. Complications after discharge included deep venous thrombosis (2.3%), reoperation (0.7%), and infection (3.2%). A readmission rate of 2.7% within the first 30 days from the time of discharge occurred. Total ankle arthroplasty in the United States is a relatively safe procedure with low overall complication rates. Patients who are male, have a history of community-acquired pneumonia, and have a larger number of preoperative comorbidities had a significant increased risk of developing 1 complication within 30 days of surgery.