Brodeur Peter G, Walsh Devin F, Modest Jacob M, Salameh Motasem, Licht Aron H, Hartnett Davis A, Gil Joseph, Cruz Aristides I, Hsu Raymond Y
Alpert Medical School of Brown University, Providence, RI, USA.
Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA.
Foot Ankle Orthop. 2022 Aug 23;7(3):24730114221117150. doi: 10.1177/24730114221117150. eCollection 2022 Jul.
Ankle arthroplasty has emerged as a viable alternative to ankle arthrodesis due in large part to recent advancements in both surgical technique and implant design. This study seeks to document trends of arthroplasty and arthrodesis for ankle osteoarthritis in New York State from 2009-2018 in order to determine if patient demographics play a role in procedure selection and to ascertain the utilization of each procedure and rates of complications.
Patients 40 years and older from 2009-2018 were identified using and ( and ), () diagnosis and procedure codes for ankle osteoarthritis, ankle arthrodesis, and ankle arthroplasty in the New York statewide planning and research cooperative system database. A trend analysis for both inpatient and outpatient procedures was performed to evaluate the changing trends in utilization of ankle arthrodesis and ankle arthroplasty over time. A multivariable logistic regression was used to assess the odds of receiving ankle arthrodesis relative to ankle arthroplasty. Complications were compared between inpatient ankle arthrodesis and arthroplasty using multivariable Cox proportional hazards regression.
A total of 3735 cases were included. Ankle arthrodesis increased by 25%, whereas arthroplasty increased by 757%. African American race, federal insurance, workers compensation, presence of comorbidities, and higher social deprivation were associated with increased odds of having an ankle arthrodesis vs an ankle arthroplasty. Compared with ankle arthroplasty, ankle arthrodesis was associated with increased rates of readmission, surgical site infection, acute renal failure, cellulitis, urinary tract infection, and deep vein thrombosis.
Ankle arthroplasty volume has grown substantially without a decrease in ankle arthrodesis volume, suggesting that ankle arthroplasty may be selectively used for a different population of patients than ankle arthrodesis patients. Despite the increased growth of ankle arthroplasty, certain patient demographics including patients from minority populations, federal insurance, and from areas of high social deprivation have higher odds of receiving arthrodesis.
Level III, retrospective cohort.
由于手术技术和植入物设计的近期进展，踝关节置换术已成为踝关节融合术的一种可行替代方案。本研究旨在记录2009年至2018年纽约州踝关节骨关节炎的置换术和融合术趋势，以确定患者人口统计学特征是否在手术选择中起作用，并确定每种手术的利用率和并发症发生率。
利用纽约州全州规划和研究合作系统数据库中踝关节骨关节炎、踝关节融合术和踝关节置换术的国际疾病分类第九版临床修订本（ICD-9-CM）和国际疾病分类第十版临床修订本（ICD-10-CM）诊断及手术编码，识别出2009年至2018年40岁及以上的患者。对住院和门诊手术进行趋势分析，以评估踝关节融合术和踝关节置换术的使用随时间的变化趋势。采用多变量逻辑回归评估接受踝关节融合术相对于踝关节置换术的几率。使用多变量Cox比例风险回归比较住院踝关节融合术和置换术之间的并发症。
共纳入3735例病例。踝关节融合术增加了25%，而置换术增加了757%。非裔美国人、联邦保险、工伤赔偿、合并症的存在以及较高的社会剥夺程度与接受踝关节融合术而非踝关节置换术的几率增加相关。与踝关节置换术相比，踝关节融合术与再入院率、手术部位感染、急性肾衰竭、蜂窝织炎、尿路感染和深静脉血栓形成的发生率增加相关。
踝关节置换术的数量大幅增长，而踝关节融合术的数量并未减少，这表明踝关节置换术可能被选择性地用于与踝关节融合术患者不同的患者群体。尽管踝关节置换术增长加快，但某些患者人口统计学特征，包括少数族裔患者、联邦保险患者以及来自社会剥夺程度高的地区的患者，接受融合术的几率更高。
三级，回顾性队列研究。
