title: Trends in treatment of advanced ankle arthropathy by total ankle replacement or ankle fusion.
abstract: BACKGROUND
  Total ankle replacement (TAR) and ankle fusion (AF) are the 2 major operative options for treatment of advanced ankle arthropathy; there is, however, no large epidemiologic study comparing nationwide trends of these 2 procedures. The current study used a nationwide database to compare epidemiologic profiles of TAR and AF.
  
  
  METHODS
  Data collected for the Nationwide Inpatient Sample (NIS) from 2000 to 2010 were reviewed. Procedures were identified by searching for ICD-9-CM codes 81.11 (AF) and 81.56 (TAR). Patients' demographics and comorbidities, geographic distribution, and cost of procedures were compared.
  
  
  RESULTS
  The NIS analysis identified 2666 TAR and 16 419 AF cases which was extrapolated to 13 145 TAR and 80 426 AF nationwide. Spearman's ρ showed an increase in the number of AF per year while the number of TAR cases remained relatively flat per year until 2006, after which there was a steady increase in the number of TAR performed. Patients receiving a TAR tended to be older, female, and white. Patients who underwent AF were more likely to be obese or diabetic than TAR patients. Both TAR and AF were performed more frequently in private urban hospitals through 2007. However, in 2010, the number of TAR procedures was greater in academic centers compared to private urban hospitals.
  
  
  CONCLUSIONS
  Despite recent increases in the number of TAR implanted, AF was still performed more than 6 times more frequently for advanced ankle arthropathy. A trend was demonstrated toward an increasing number of TAR being implanted in academic centers, and in patients with more underlying comorbidities than was previously seen.
  
  
  METHODS
  Level II, prognostic study.
authors.affiliation: Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Raikin
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
authors.forename: Ramin
authors.initials: R
authors.lastname: Espandar
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D019643:Arthroplasty, Replacement / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011379:Prognosis; D014494:Unithiol
chemical_list: D014494:Unithiol
keywords: ankle fusion; nationwide inpatient sample; total ankle arthroplasty