Younger Alastair S E, MacLean Scott, Daniels Timothy R, Penner Murray J, Wing Kevin J, Dunbar Michael, Glazebrook Mark
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
Division of Orthopaedics, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada Dalhousie University, Halifax, NS, Canada.
Foot Ankle Int. 2015 Mar;36(3):253-7. doi: 10.1177/1071100714558844. Epub 2014 Nov 3.
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.
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.
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.
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.
在大多数医疗保健系统中，患有终末期髋关节炎和膝关节炎的患者都可以接受全髋关节置换术（THA）和全膝关节置换术（TKA）。由于假体成本的原因，患有终末期踝关节炎的患者往往无法获得全踝关节置换术（TAA）。踝关节融合术（AF）通常是唯一的替代方案。患者应能平等地获得总成本相当的手术。我们在一家政府资助的教学医院中，比较了类似队列的TAA、AF、THA和TKA的总成本。
从加拿大矫形足踝协会前瞻性踝关节重建数据库中选取13例TAA患者和13例AF患者作为子集，并从加拿大关节置换登记处随机选取13例THA患者和13例TKA患者。根据手术室时间、住院时间、外科医生计费和使用的设备估算总成本。
TAA的平均总成本为13500美元±1000美元，与THA（14500美元±1500美元）和TKA（12500美元±1000美元）相同。AF的平均总成本显著较低，为5500美元±500美元。与THA和TKA相比，踝关节手术的平均手术室时间较长，但平均住院时间较短。
所有关节置换术的总成本相似。不应仅因假体成本而拒绝全踝关节置换术，因为整个手术成本与THA和TKA相当。我们认为，对于某些患者群体来说，踝关节融合术是一种成本较低且更可取的替代方案。
