title: Effect of Insurance on Rates of Total Ankle Arthroplasty Versus Arthrodesis for Tibiotalar Osteoarthritis.
abstract: BACKGROUND
  Several studies have examined the effect of insurance on the management of various orthopedic conditions. The purpose of our study was to assess the effect of insurance and other demographic factors on the operative management of tibiotalar osteoarthritis.
  
  
  METHODS
  The National Inpatient Sample (NIS) database was used to identify patients who underwent a total ankle arthroplasty (TAA) or tibiotalar arthrodesis (TTA) for tibiotalar osteoarthritis. Insurance status was identified for each patient, and the proportions of each insurance type were computed for each operative modality. A multivariate analysis was performed to account for confounding variables to isolate the effect of insurance type on operative treatment.
  
  
  RESULTS
  From 2007 to 2012, a total of 10 010 patients (35.6%) were identified who underwent a total ankle replacement (TAR) procedure and 18 094 patients (64.4%%) who underwent TTA for tibiotalar osteoarthritis. Patients receiving a TAR were older (65.8 vs 64.2, P < .001), more likely to be female (54% vs 51%, P < .001), and had fewer comorbidities (4.2 vs 4.5, P < .001) than patients who underwent a TTA. After controlling for baseline differences, patients with Medicare (odds ratio [OR] 3.00, P < .001), and private insurance (OR 3.19, P < .001) were approximately 3 times more likely to undergo TAR than patients with Medicaid.
  
  
  CONCLUSIONS
  Patients with tibiotalar osteoarthritis were more likely to receive a TAR procedure if they had Medicare or private insurance compared with patients who had Medicaid. Further research should be done to better understand the drivers of this phenomenon if equitable care is to be achieved.
  
  
  METHODS
  Level II, prognostic study.
authors.affiliation: 1 Department of Orthopaedic Surgery, Keck School of Medicine at USC, Los Angeles, CA, USA.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Heckmann
authors.affiliation: 1 Department of Orthopaedic Surgery, Keck School of Medicine at USC, Los Angeles, CA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bradley
authors.affiliation: 2 Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Sivasundaram
authors.affiliation: 1 Department of Orthopaedic Surgery, Keck School of Medicine at USC, Los Angeles, CA, USA.
authors.forename: Ram Kiran
authors.initials: RK
authors.lastname: Alluri
authors.affiliation: 1 Department of Orthopaedic Surgery, Keck School of Medicine at USC, Los Angeles, CA, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Tan
mesh_terms: D017677:Age Distribution; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000706:statistics & numerical data*; D058737:Arthroplasty, Replacement, Ankle / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States
keywords: ankle arthrodesis; tibiotalar osteoarthritis; total ankle arthroplasty