Does Total Ankle Arthroplasty Belong in the Comprehensive Care for Joint Replacement?

Boylan, Matthew R.; Riesgo, Aldo M.; Paulino, Carl B.; Sheskier, Steven C.

doi:10.1053/j.jfas.2017.08.008

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…In contrast, prior investigations have reported that referral to nursing or rehabilitation facilities following TAA approached 20%, and that PT use following TAA approached 10%. 3,30 However, Rajapakshe et al 30 acknowledged that PT use following TAA in their study was likely underestimated. To this point, nearly 90% of our sample received several PT visits (Table 2).…”

Section: Discussionmentioning

confidence: 92%

“…Few studies have reported on the frequency of rehabilitation or PT, or provided discussion regarding rehabilitation approaches following TAA. 3,17,19,30 Accordingly, the frequency, patient perceived value, and potential influence PT has on patient-reported outcomes is unexplored. However, obtaining a profile of PT use and value is the first step to developing and modifying current rehabilitation approaches to leverage TAA operative success.…”

Section: Introductionmentioning

confidence: 99%

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Overall Health and the Influence of Physical Therapy on Physical Function Following Total Ankle Arthroplasty

et al. 2020

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Background: The overall health and the importance of physical therapy for people following total ankle arthroplasty (TAA) have been understudied. Our purpose was to characterize the overall health of patients following TAA, and explore the frequency, influence, and patient-perceived value of physical therapy. Methods: People who received a TAA participated in this retrospective cohort online survey study. The survey included medical history questions and items from the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Forms. Seven PROMIS domains, reflecting the biopsychosocial model of care (physical, mental, social), were included to examine participant overall health status in comparison to the general population. Items regarding physical therapy participation (yes/no), number of visits, and perceived value (scale 0-10; 10 = extremely helpful) were also included. Descriptive statistics were generated for participant characteristics, PROMIS domain T scores, and physical therapy questions. The influence of participant characteristics or physical therapy visits on PROMIS domain T scores that scored below the population mean were examined with multiple linear regression or ordinal regression. Results: The response rate was 61% (n=95). Average postoperative time was approximately 3 years (mean [SD]: 40.0 [35.3] months). Physical function and ability to participate in social roles and activities domain T scores were at least 1 SD below the population mean. Most patients received physical therapy (86%; 17.1 [11.0] visits) and found it helpful (7.2 [3.0]). Participant characteristics were minimally predictive of physical function and social participation T scores. Number of physical therapy visits predicted physical function T scores ( P = .03). Conclusions: Most health domain scores approached the population mean. Physical therapy was perceived to have a high value, and greater visits were related to greater physical function. However, lower physical function and social participation scores suggest that postoperative care directed toward these domains could improve the value of TAA and promote overall health. Level of Evidence: Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Overall Health and the Influence of Physical Therapy on Physical Function Following Total Ankle Arthroplasty

et al. 2020

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“…This may indicate that length of stay and discharge location, rather than 90-day readmission, may be driving the lower rates of CJR target overruns observed in the TAA cohort compared with THA/TKA patients. Using the SPARCS database, Boylan et al 1 performed a similar comparison between TAA and THA/TKA and also found shorter length of stay and lower rates of discharge to post–acute care as well as no significant difference in 90-day readmissions (4.9%). In contrast to the present study, they found slightly higher costs in TAA compared with THA/TKA ($20 817 vs $17 613).…”

Section: Discussionmentioning

confidence: 97%

“…7,12,19,21 Within the TAA literature, however, relatively few studies have examined length of stay, post–acute care, or readmissions in a bundled payment context, and none have examined how often costs exceed the bundled payment target. 1,4-6…”

mentioning

confidence: 99%

“…7,12,19,21 Within the TAA literature, however, relatively few studies have examined length of stay, post-acute care, or readmissions in a bundled payment context, and none have examined how often costs exceed the bundled payment target. 1,[4][5][6] The purpose of this study was to (1) determine the rate at which TAA costs exceed the CJR target payments (primary outcome), (2) investigate patient demographics and comorbidities associated with exceeding CJR targets, and (3) compare these results with a similar institutional cohort of total hip and knee arthroplasty cases performed during the same period.…”

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confidence: 99%

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Patients at Risk for Exceeding CJR Cost Targets After Total Ankle Arthroplasty

et al. 2019

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Background: The Comprehensive Care for Joint Replacement (CJR) model includes total ankle arthroplasty (TAA), under which a target reimbursement is established. Whether this reimbursement is sufficient to cover average cost remains unknown. We hypothesized that a substantial number of TAAs still exceed cost targets, and that risk factors associated with exceeding the target cost could be identified preoperatively. Methods: Two hundred two primary TAAs performed at a single tertiary referral center under the CJR model from June 2013 to May 2017 were retrospectively reviewed. Patient demographics, comorbidities, outcomes, and costs were extracted from the electronic medical record using a validated structured query language (SQL) algorithm. A comparison cohort of 2084 CJR total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases performed during the same period was also reviewed. Results: Twenty TAAs (10%) exceeded the target cost of care, significantly fewer than CJR THAs/TKAs (29%) performed during the same period ( P < .0001). These patients did not differ significantly in age, sex, body mass index, number of Elixhauser comorbidities, or the American Society of Anesthesiologists score. The average cost for these patients was $17 338 higher than those who did not exceed the target cost, and they were less likely to be married or have a partner (45% vs 79%, P = .001). Non-Caucasian status also reached significance ( P < .0001). Those exceeding the target cost had a significantly longer length of stay (2.6 vs 1.5 days, P < .0001) and were more likely to be discharged to either skilled nursing or a rehabilitation facility (60% vs 1%, P < .0001). Conclusion: Even high-volume TAA centers still exceed target costs in up to 10% of cases, with length of stay, discharge location, and readmissions driving many of these events. Potential risk factors for excess cost include marital/partner status and non-Caucasian ethnicity, but further work is needed to clarify their effects and whether other risk factors exist. Level of Evidence: Level III, comparative study.

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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature

Primeau

Joshi

Zomar

et al. 2020

Curr Treat Options in Rheum

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Does Total Ankle Arthroplasty Belong in the Comprehensive Care for Joint Replacement?

Cited by 8 publications

References 18 publications

Overall Health and the Influence of Physical Therapy on Physical Function Following Total Ankle Arthroplasty

Overall Health and the Influence of Physical Therapy on Physical Function Following Total Ankle Arthroplasty

Patients at Risk for Exceeding CJR Cost Targets After Total Ankle Arthroplasty

Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature

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