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Is Total Ankle Arthroplasty Adequately Compensated? A Propensity Score-matched Comparison of Work Relative Value
Andrew D Lachance1, Patrick Sun, Wonyong Lee
1From the Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA (Lachance), Pritzker School of Medicine at the University of Chicago, Chicago, IL (Sun), and Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL (Lee).
Background:
Total ankle arthroplasty (TAA) is among the most technically demanding joint arthroplasties; however, the adequacy of its compensation has not been thoroughly examined. Work relative value units (wRVUs), a key metric for physician reimbursement, are assigned based on the complexity and time associated with clinical activities. This study aims to evaluate whether TAA is adequately compensated compared with total knee arthroplasty (TKA), total hip arthroplasty (THA), and total shoulder arthroplasty (TSA), using the National Surgical Quality Improvement Program (NSQIP) database.
Methods:
Arthroplasty procedures, including TAA, TKA, THA, and TSA, were identified using Current Procedural Terminology codes within the NSQIP database from 2020 to 2022. A 1:1 propensity score matching was done using the TAA group as the reference, matched across groups by age (±1 year) and sex. The adequacy of TAA compensation was assessed based on wRVUs, surgical time (OT), wRVUs per hour (wRVU/hour), and reimbursement rates ($/hour), in comparison to other joint arthroplasties. Postoperative complications within 30 days were evaluated to compare procedural risk profiles.
Results:
After propensity score matching, 511 cases were identified per group. TAA was associated with a markedly longer surgical time compared with other joint arthroplasties (TKA, THA, TSA): 135.69 versus 91.66, 97.82, and 96.77 minutes, respectively ( P < 0.001). In addition, TAA demonstrated a markedly lower mean wRVU/hour (7.17 versus 13.84, 13.13, and 15.86, respectively; P < 0.001) and reimbursement rate (231.77 versus 447.81, 424.73, and 513.12 $/hour, respectively; P < 0.001). These trends remained consistent after adjusting for preoperative comorbidities and postoperative complication rates.
Conclusions:
Despite requiring markedly longer OT, TAA was associated with substantially lower wRVU/hour and reimbursement rate. Our results suggest that the current wRVU scale may inadequately compensate for TAA, particularly in comparison to other joint arthroplasty procedures. These findings highlight the potential need to reevaluate wRVU allocation for TAA to ensure more equitable and appropriate compensation.
Level Of Evidence:
Level III.
