Trends in Complication Rates Following Ankle Arthrodesis and Total Ankle Replacement

Background: This study provides an updated comparison of the reoperation rates following primary ankle arthrodesis and total ankle replacement on the basis of observational, population-based data from California. We previously reported data from 1995 to 2004, and our current study includes new data from 2005 to 2010. Our hypothesis was that total ankle replacement would demonstrate increasing utilization and lower complication rates given advances in implant design and growth in surgeon experience. Methods: California's hospital discharge database was used to identify patients who had undergone primary ankle arthrodesis or total ankle replacement between 1995 and 2010. Short-term outcomes examined were based on Centers for Medicaid & Medicare Services (CMS) surgical quality measures and included readmission for any cause, death, and readmission for 7 common surgical complications (acute myocardial infarction, pneumonia, sepsis, pulmonary embolism, mechanical complications, surgical-site bleeding, and periprosthetic joint infection or wound infection). Long-term outcomes analyzed included rates of major revision surgery (ankle arthrodesis or ankle replacement, adjacent joint procedures (subtalar arthrodesis, triple arthrodesis, tarsometatarsal arthrodesis, and total knee replacement), and below-the-knee amputation. Logistic and proportional hazard regression models were used to estimate the impact of ankle arthrodesis or total ankle replacement on the rates of adverse outcomes, with adjustment for patient factors such as age, sex, race, type of health insurance, and comorbidities. We also compared patients in the 2005 to 2010 cohort with those in the earlier cohort. Results: In all, 8,491 ankle arthrodesis and 1,280 total ankle replacement cases were identified. Patients managed with ankle replacement were more likely to be female, white, and older and to have Medicare or private health insurance. Shortterm complication risk was low for both procedures, and patients managed with total ankle replacement had significantly lower rates of readmission (p < 0.0001) and periprosthetic joint infection/wound infection (p = 0.02) compared with patients managed with ankle arthrodesis. Conclusions: The inclusion of new data on patients who underwent surgery between 2005 and 2010 demonstrates increasing utilization and lower complication rates for total ankle replacement compared with ankle arthrodesis. These findings suggest that there have been improvements in the clinical safety of total ankle replacement over time.