The Fall and Rise of Total Ankle Arthroplasty: A Database Analysis of Procedural Incidence Between 2009 and 2019

Abstract

Category: Ankle; Ankle Arthritis; Hindfoot; Trauma Introduction/Purpose: Ankle osteoarthritis accounts for one of the most common ankle joint pathologies. Although total ankle arthrodesis has been the mainstay treatment for degenerative end-stage ankle arthritis, the popularity of total ankle arthroplasty has been on the rise due improved implant design, technologies, and postoperative outcomes. Yet, there remains a paucity of epidemiologic data in recent years on the incidence of total ankle arthroplasty in the United States. We hypothesize that stratified incidences of patients undergoing this procedure in the last decade has risen. Methods: The Truven MarketScan database was queried to identify patients who underwent total ankle arthroplasty from January 2009 to December 2019 based on CPT coding. Population estimates from the US Census Bureau were used to calculate the annual incidence of total ankle arthroplasty. Volume and incidence were estimated for annual sums, gender, age subgroups, and four statistical geographical regions of the U.S. Results: In total, 41,060 total ankle arthroplasty procedures were identified in the database from 2009 to 2019. Annual volumes have increased significantly by 136.1%, from 2,180 to 5,147 total procedures nationwide. Procedural incidence reported per 1,000,000 people significantly increased by 120.8%, at 15.9 in 2019. Significant growth in incidence was demonstrated in males and females below the age of 65 years with the highest annual incidence found in people under the age of 54. Incidence stratified by region rose in all regions of the United States with the South and West seeing the most notable increases. Conclusion: The epidemiology of TAA has yet to be clarified in recent years. We found that annual volumes and incidence of TAA has increased in the past decade. Growth in incidence was demonstrated in both sexes > 54 years as well as in all regions of the US. While ankle arthroplasty succeeds in mitigating certain complications associated with arthrodesis such as impaired ankle motion, gait changes and adjacent joint arthritis, orthopedic surgeons must remain mindful of the significant consequences associated with revision ankle arthroplasty. Describing epidemiology with stratified procedural incidence can help orthopedists adapt to the ever-evolving changes in the field.