Clinical Rheumatology

, Volume 35, Issue 1, pp 239–245 | Cite as

Time trends in total ankle arthroplasty in the USA: a study of the National Inpatient Sample

Brief Report


The objective of this study was to assess the time trends in utilization, clinical characteristics, and outcomes of patients undergoing total ankle arthroplasty (TAA) in the USA. We used the Nationwide Inpatient Sample (NIS) data from 1998 to 2010 to examine time trends in the utilization rates of TAA. We used the Cochran Armitage test for trend to assess time trends across the years and the analysis of variance (ANOVA), Wilcoxon test, or chi-squared test (as appropriate) to compare the first (1998–2000) and the last time periods (2009–2010). TAA utilization rate increased significant from 1998 to 2010: 0.13 to 0.84 per 100,000 overall, 0.14 to 0.88 per 100,000 in females, and from 0.11 to 0.81 per 100,000 in males (p < 0.0001 for each comparison for time trends). Compared to the 1998–2000 period, those undergoing TAA in 2009–2010 were older (41 % fewer patients <50 years, p < 0.0001), less likely to have rheumatoid arthritis as the underlying diagnosis (55 % fewer patients, p = 0.0001), more likely to have Deyo-Charlson index of 2 or more (197 % more, p = 0.0010), and had a shorter length of stay at 2.5 days (17 % reduction, p < 0.0001). Mortality was rare ranging from 0 to 0.6 % and discharge to inpatient facility ranged 12.6–14.1 %; we noted no significant time trends in either (p > 0.05). The utilization rate of TAA increased rapidly in the USA from 1998 to 2010, but post-arthroplasty mortality rate was stable. Underlying diagnosis and medical comorbidity changed over time and both can impact outcomes after TAA. Further studies should examine how the outcomes and complications of TAA have evolved over time.


Ankle arthroplasty Outcomes Sex Time trends Utilization 


  1. 1.
    Maffulli N (2010) Recent advances in foot and ankle surgery: editorial comment. Clin Orthop Relat Res 468(4):921PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Park JS, Mroczek KJ (2011) Total ankle arthroplasty. Bull NYU Hosp Jt Dis 69(1):27–35PubMedGoogle Scholar
  3. 3.
    Coester LM, Saltzman CL, Leupold J, Pontarelli W (2001) Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am 83-A(2):219–228PubMedGoogle Scholar
  4. 4.
    Anderson T, Montgomery F, Carlsson A (2003) Uncemented STAR total ankle prostheses. Three to eight-year follow-up of fifty-one consecutive ankles. J Bone Joint Surg Am 85-A(7):1321–1329PubMedGoogle Scholar
  5. 5.
    Knecht SI, Estin M, Callaghan JJ, Zimmerman MB, Alliman KJ, Alvine FG et al (2004) The agility total ankle arthroplasty. Seven to sixteen-year follow-up. J Bone Joint Surg Am 86-A(6):1161–1171PubMedGoogle Scholar
  6. 6.
    Bai LB, Lee KB, Song EK, Yoon TR, Seon JK (2010) Total ankle arthroplasty outcome comparison for post-traumatic and primary osteoarthritis. Foot Ankle Int 31(12):1048–1056PubMedCrossRefGoogle Scholar
  7. 7.
    Conti SF, Wong YS (2001) Complications of total ankle replacement. Clin Orthop Relat Res 391:105–114PubMedCrossRefGoogle Scholar
  8. 8.
    Skytta ET, Koivu H, Eskelinen A, Ikavalko M, Paavolainen P, Remes V (2010) Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register. Acta Orthop 81(1):114–118PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Hosman AH, Mason RB, Hobbs T, Rothwell AG (2007) A New Zealand national joint registry review of 202 total ankle replacements followed for up to 6 years. Acta Orthop 78(5):584–591PubMedCrossRefGoogle Scholar
  10. 10.
    Louie GH, Ward MM (2010) Changes in the rates of joint surgery among patients with rheumatoid arthritis in California, 1983–2007. Ann Rheum Dis 69(5):868–871PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Kim SH, Wise BL, Zhang Y, Szabo RM (2011) Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am 93(24):2249–2254PubMedCrossRefGoogle Scholar
  12. 12.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMedCrossRefGoogle Scholar
  13. 13.
    Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR (2012) Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010. JAMA 308(12):1227–1236PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Raikin SM, Rasouli MR, Espandar R, Maltenfort MG (2014) Trends in treatment of advanced ankle arthropathy by total ankle replacement or ankle fusion. Foot Ankle Int 35(3):216–224PubMedCrossRefGoogle Scholar
  15. 15.
    Healthcare Cost and Utilization Project. Overview of the Nationwide Inpatient Sample (NIS). Last updated 2/19/13. Rockville, MD: AHRQ; 2012 [6/14/13].
  16. 16.
    Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT et al (2012) Comparison of outcomes of laparoscopic versus open appendectomy in children: data from the Nationwide Inpatient Sample (NIS), 2006–2008. World J Surg 36(3):573–578PubMedCrossRefGoogle Scholar
  17. 17.
    Shivaraju A, Patel V, Fonarow GC, Xie H, Shroff AR, Vidovich MI (2011) Temporal trends in gastrointestinal bleeding associated with percutaneous coronary intervention: analysis of the 1998–2006 Nationwide Inpatient Sample (NIS) database. Am Heart J 162(6):1062–8 e5PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Vassileva CM, Shabosky J, Boley T, Markwell S, Hazelrigg S (2012) Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg 143(5):1043–1049PubMedCrossRefGoogle Scholar
  19. 19.
    Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT et al (2011) Comparison of outcomes of laparoscopic versus open appendectomy in adults: data from the Nationwide Inpatient Sample (NIS), 2006–2008. J Gastrointest Surg Off J Soc Surg Aliment Tract 15(12):2226–2231CrossRefGoogle Scholar
  20. 20.
    Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619PubMedCrossRefGoogle Scholar
  21. 21.
    Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 87(7):1487–1497PubMedCrossRefGoogle Scholar
  22. 22.
    Cram P, Lu X, Kaboli PJ, Vaughan-Sarrazin MS, Cai X, Wolf BR et al (2011) Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991–2008. JAMA 305(15):1560–1567PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Jain NB, Higgins LD, Guller U, Pietrobon R, Katz JN (2006) Trends in the epidemiology of total shoulder arthroplasty in the United States from 1990–2000. Arthritis Rheum 55(4):591–597PubMedCrossRefGoogle Scholar
  24. 24.
    Jain NB, Higgins LD, Ozumba D, Guller U, Cronin M, Pietrobon R et al (2005) Trends in epidemiology of knee arthroplasty in the United States, 1990–2000. Arthritis Rheum 52(12):3928–3933PubMedCrossRefGoogle Scholar
  25. 25.
    Jain N, Pietrobon R, Hocker S, Guller U, Shankar A, Higgins LD (2004) The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am 86-A(3):496–505PubMedGoogle Scholar
  26. 26.
    Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA et al (2001) Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 83-A(11):1622–1629PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2014

Authors and Affiliations

  1. 1.Birmingham VA Medical CenterBirminghamUSA
  2. 2.Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public HealthUniversity of AlabamaBirminghamUSA
  3. 3.Department of Orthopedic SurgeryMayo Clinic College of MedicineRochesterUSA

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