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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Primary total ankle replacement surgery is a cost-effective intervention.

Zach J Place1, Deborah J Macdonald2, Nicholas D Clement2

  • 1The University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, United Kingdom.

Foot (Edinburgh, Scotland)
|September 18, 2021
PubMed
Summary

Primary total ankle replacement (PTAR) is cost-effective for end-stage ankle arthritis in the UK. Lower pre-operative health scores predict better outcomes, with scores above 0.57 being less cost-effective.

Keywords:
AnkleAnkle replacementArthroplastyCost-effectiveTAR

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Area of Science:

  • Orthopaedic surgery
  • Health economics
  • Quality of Life research

Background:

  • End-stage ankle arthritis significantly impacts patient Quality of Life (QoL).
  • Total ankle replacement (TAR) is an established surgical option, but its cost-effectiveness in the UK requires evaluation.
  • Primary total ankle replacement (PTAR) aims to restore function and alleviate pain.

Purpose of the Study:

  • To determine the cost-effectiveness of PTAR in the UK.
  • To identify predictors of increased cost-effectiveness for PTAR.
  • To establish a threshold for cost-effectiveness based on pre-operative patient data.

Main Methods:

  • A 90-month prospective study across two UK centres.
  • Collected pre-operative and six-month post-operative data.
  • Utilized EuroQol general health questionnaire (EQ-5D-3L) for QoL and Manchester-Oxford Foot Questionnaire (MOXFQ) for joint function.
  • Analyzed demographic data and pre-operative scores as predictors of QALYs gained.
  • Defined cost-effectiveness as a cost per QALY of less than £20,000.

Main Results:

  • The cohort comprised 51 patients (mean age 67.7, 58.8% male), with 47.7% classified as obese or higher.
  • The initial cost per QALY gained was £1669.
  • Including annual health gain reduction and discounting, the cost per QALY rose to £4466.
  • Lower pre-operative EQ-5D-3L scores significantly correlated with greater QALYs gained (p < 0.01).
  • No other demographic or pre-operative factors significantly predicted QALY gains.

Conclusions:

  • PTAR is a cost-effective intervention for end-stage ankle arthritis in the UK.
  • Pre-operative EQ-5D-3L scores are a significant predictor of QALY gains.
  • PTAR may not be cost-effective for patients with a pre-operative EQ-5D-3L score of 0.57 or higher.