title: Initial hospital-related cost comparison of total ankle replacement and ankle fusion with hip and knee joint replacement.
abstract: BACKGROUND
  Total hip and knee arthroplasty (THA and TKA) are accessible to patients with end-stage hip and knee arthritis in most health care systems. The availability of total ankle arthroplasty (TAA) to patients with end-stage ankle arthritis is often restricted because of prosthesis cost. Ankle fusion (AF) is often offered as the only alternative. Patients should have equal access to procedures that are equivalent in total cost. We compared total costs of TAA, AF, THA, and TKA for similar cohorts in a government-funded teaching hospital.
  
  
  METHODS
  A subset of 13 TAA and 13 AF patients were selected from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database, and 13 THA and 13 TKA patients were randomly selected from the Canadian Joint Replacement Registry. Total cost was estimated from operating room time, hospital stay, surgeon billing, and equipment used.
  
  
  RESULTS
  Mean total cost associated with TAA was $13,500 ± 1000 and was the same as THA ($14,500 ± 1500) and TKA ($12,500 ± 1000). Mean total cost associated with AF was significantly less at $5500 ± 500. Mean operating room time was longer, but mean hospital stay was shorter for the ankle procedures compared with THA and TKA.
  
  
  CONCLUSIONS
  All arthroplasties had similar total costs. Total ankle arthroplasty should not be denied based on prosthetic cost alone, as total procedure cost is equivalent to THA and TKA. We believe ankle fusion is a less expensive and preferable alternative for some patient groups.
authors.affiliation: Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada BC's Foot and Ankle Clinic, St Paul's Hospital, Vancouver, BC, Canada asyounger@shaw.ca.
authors.forename: Alastair S E
authors.initials: AS
authors.lastname: Younger
authors.affiliation: Division of Orthopaedics, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada Dalhousie University, Halifax, NS, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: MacLean
authors.affiliation: Division of Orthopaedic Surgery, St Michael's Hospital and University of Toronto, Toronto, ON, Canada.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Daniels
authors.affiliation: Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada BC's Foot and Ankle Clinic, St Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Murray J
authors.initials: MJ
authors.lastname: Penner
authors.affiliation: Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada BC's Foot and Ankle Clinic, St Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Wing
authors.affiliation: Division of Orthopaedics, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada Dalhousie University, Halifax, NS, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Dunbar
authors.affiliation: Division of Orthopaedics, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada Dalhousie University, Halifax, NS, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Glazebrook
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery*; D001174:Arthrodesis / Q000191:economics*; D058737:Arthroplasty, Replacement, Ankle / Q000191:economics*; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D002170:Canada; D003365:Costs and Cost Analysis / Q000379:methods*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged
keywords: ankle arthroplasty; ankle fusion; arthroplasty; cost analysis