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Published on: January 24, 2018
Evaluation of Surgical Costs Associated With Total Ankle Arthroplasty
Taylor Mendenhall1, Chong Zhang, Angela Presson
1From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mendenhall and Nixon), and the Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT (Zhang and Presson).
Background:
Growing attention is being paid to the costs associated with various orthopaedic surgeries, but limited data exist on the costs associated with total ankle arthroplasty (TAA). This study compared surgical costs between two established TAA systems (Zimmer Trabecular Metal and Salto Talaris).
Methods:
Patients who underwent primary TAA were retrospectively identified at one academic institution from 2012 to 2024. Total direct costs, facility costs, and implant costs were assessed using an institutional Value Driven Outcome tool which includes an item-level database capturing detailed cost data. Costs were converted to equivalent 2022 US dollars and analyzed using gamma regression adjusting for age, body mass index (BMI), surgery location, and year of surgery to report cost ratios with 95% confidence intervals (CIs). TAA costs over time were also studied.
Results:
In total, 208 patients who underwent primary TAA were analyzed. Total direct costs and facility costs increased over time for both Zimmer Trabecular Metal (N = 177) and the Salto Talaris (N = 31) implants. The rate of the cost increase was faster for Salto Talaris at 6% per year (ratio 1.06, 95% CI, 1.04 to 1.07) compared with Zimmer Trabecular Metal at 1.4% per year (ratio 1.014, CI, 1.008 to 1.02; P < 0.001). Total surgical time was longer for the Zimmer Trabecular Metal group (median 3.3 hours, interquartile range, 3.0 to 3.7) compared with the Salto Talaris group (median 3.1 hours, interquartile range, 2.8 to 3.3; P = 0.034). Implant costs constituted the bulk of total direct costs for the Salto Talaris (70%) and Zimmer Trabecular Metal (67%) groups.
Conclusion:
Comparing TAA surgeries with either the Zimmer Trabecular Metal or Salto Talaris implants, total direct costs for each arthroplasty type rose at different rates over time. As increasing numbers of total ankle systems enter the marketplace, it will be important to better understand surgical costs given the expanding utilization of TAA.
Level Of Evidence:
Level III, retrospective comparative study.
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