Insurance Status and Patient Outcomes After Total Ankle Arthroplasty.

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Biostatistics

Background:

• Total ankle arthroplasty (TAA) is increasingly preferred over ankle fusion for osteoarthritis.
• Understanding how insurance type influences TAA outcomes is critical for equitable patient care.
• This study investigates disparities in TAA outcomes between Medicare and commercially insured (PPO/HMO) patients.

Purpose of the Study:

• To compare clinical characteristics, complications, reoperations, and patient-reported outcomes following TAA based on insurance type.
• To identify potential disparities in TAA outcomes associated with Medicare versus PPO/HMO insurance coverage.

Main Methods:

• Retrospective cohort study of 830 TAA patients (May 2010-June 2024).
• Patients stratified into Medicare (n=401) and PPO/HMO (n=429) cohorts.
• Analysis included demographics, comorbidities (Charlson Comorbidity Index), length of stay, prior surgery rates, and patient-reported outcomes (VAS pain, FAAM scores) at 1 year post-surgery.

Main Results:

• Medicare patients were older, had higher comorbidity burden, and longer hospital stays.
• PPO/HMO patients had higher rates of prior ankle surgery and preoperative pain.
• Postoperative pain scores, reoperation rates, readmissions, and return to activity were similar between groups.

Conclusions:

• Insurance type is linked to differences in patient demographics and preoperative health status for TAA.
• Despite baseline differences, Medicare and PPO/HMO patients achieve comparable postoperative clinical and functional outcomes after TAA.
• These findings suggest that insurance type does not create significant disparities in TAA recovery and success.