Abstract:
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.
journal_name
Foot Ankle Intjournal_title
Foot & ankle internationalauthors
Goltz DE,Ryan SP,Howell CB,Bolognesi MP,Seyler TM,Adams SBdoi
10.1177/1071100719853494subject
Has Abstractpub_date
2019-09-01 00:00:00pages
1025-1031issue
9eissn
1071-1007issn
1944-7876journal_volume
40pub_type
杂志文章abstract:BACKGROUND:Achilles tendon lengthening is an important part of the operative management of numerous foot and ankle disorders. The most commonly used percutaneous technique involves three hemitenotomies: medial, lateral, and medial. The discovery that Achilles tendon fibers may undergo external torsion created concern t...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110070602701116
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:We present the results of an alternative technique for decompression of a Morton intermetatarsal neuroma that is minimally invasive and does not require endoscopic instrumentation. METHODS:Seventeen nerve decompressions were performed in 14 patients using an instrument designed to release the transverse car...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.3113/FAI.2007.0263
更新日期:2007-02-01 00:00:00
abstract::Heel cord advancement has been advocated for treatment of spastic equinus deformity. Transferring the gastrosoleus anteriorly weakens it by changing the lever arm rather than the resting length. A retrospective review of 90 children with 122 limbs undergoing heel cord advancement revealed 11% excellent, 53% good, and ...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110079401501003
更新日期:1994-10-01 00:00:00
abstract::Tarsal coalition is a bridging between the tarsal bones of the foot. The bridge may be composed of bone, cartilage, fibrous tissue, or a combination of these. When symptomatic, patients usually present with hindfoot pain and frequent sprains as children, adolescents, or young adults. The classical appearance is a rigi...
journal_title:Foot & ankle international
pub_type: 杂志文章,评审
doi:10.1177/107110079601700509
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Anatomic reduction and fixation of the syndesmosis in traumatic injuries is paramount in restoring function of the tibiotalar joint. While overcompression is a potential error, recent work has called into question whether ankle position during fixation really matters in this regard. Our study aimed to corrob...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/1071100718759966
更新日期:2018-06-01 00:00:00
abstract:HYPOTHESIS:Rheumatoid arthritis is a common disabling form of arthritis that frequently affects the hands and feet. With time, the majority of affected individuals will become disabled. METHODS:Sixty-nine consecutively selected mild to moderately affected individuals with rheumatoid arthritis provided demographic data...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110070402500105
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Insufficient or excessive bony constraint surrounding the talus might contribute to the occurrence of ligamentous injury or bone contusion, respectively, at the time of ankle inversion injuries. This study aimed to investigate the relationship between radiographic lateral ankle instability and osteochondral ...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/1071100719868476
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:Evans showed that lengthening the lateral column by inserting structural bone graft into the anterior calcaneus could correct abduction and valgus deformity in flatfoot. To better understand the mechanism of correction and the three-dimensional effect of this procedure a cadaver study was done. METHODS:Thre...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110070502600209
更新日期:2005-02-01 00:00:00
abstract::Measurements of the vertical component of ground reaction force (ORF) and dynamic center of pressure (COP) were recorded for five subjects with midfoot level amputations and six with Syme's ankle disarticulation amputations. All of the subjects underwent amputation surgery as a consequence of peripheral vascular disea...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110079701801006
更新日期:1997-10-01 00:00:00
abstract::Sixty-three patients (118 toes) were evaluated at an average 61 month follow-up following PIP resection arthroplasty for a fixed hammertoe deformity. The deformity involved the second toe in 35%, the third toe in 21%, the fourth toe in 24%, and the fifth toe in 20%. The involved toe averaged 2 mm. greater length than ...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110070002100202
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy. METHODS:From May 2005 to November 2008, 24 patients (26 feet) with calcaneal malunions after a displaced intra-articular calcaneal fracture were treated...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/1071100713479766
更新日期:2013-05-01 00:00:00
abstract::A sprain to the tibial-fibular syndesmosis often results in prolonged rehabilitation or surgical intervention before recovery occurs. This paper documents gait recovery both before and after surgery for a syndesmosis sprain. Ground reaction force (GRF) data were available before injury and before surgery. Data were al...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110079501601014
更新日期:1995-10-01 00:00:00
abstract::Unnecessary amputations can be avoided with the healing of foot ulcerations in neuropathic feet. Traditional approaches have relied on relieving plantar and other extrinsic foot pressures. A retrospective review was performed of the office records of patients with Wagner grade 1 and 2 neuropathic forefoot ulcerations ...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110079701800707
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:A previous study has shown an increased radiographic prevalence and severity of hallux valgus interphalangeus (HVIP) after surgical correction of hallux valgus (HV) due to correction of pronation deformity. The purpose of this study was to evaluate the change in pre- and postoperative HVIP deformity with cor...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/1071100715579905
更新日期:2015-08-01 00:00:00
abstract:UNLABELLED:We developed a continuous lateral sciatic nerve infusion technique for postoperative analgesia. METHODS:A 10-cm insulated Tuohy needle connected to a nerve stimulator was introduced posteriorly between the biceps femoris and vastus lateralis groove 10 cm cephalad from the tip of the patella. After proper po...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110070202300812
更新日期:2002-08-01 00:00:00
abstract:BACKGROUND:The traditional operative management of Haglund deformity and retrocalcaneal bursitis consists of an open excision of the inflamed bursa, resection of the posterosuperior calcaneal tuberosity, and debridement of the Achilles tendinopathy. In an effort to reduce morbidity and recovery time, an endoscopic tech...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.3113/FAI.2007.0149
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Subtalar bone-block distraction arthrodesis using structural autograft carries the risk of donor site morbidity. Recent reports suggest that structural allograft may be an attractive alternative to structural autograft in subtalar arthrodesis. This prospective study analyzes subtalar distraction arthrodesis ...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.3113/FAI.2008.0561
更新日期:2008-06-01 00:00:00
abstract::This study examined stance phase foot kinematics, kinetics and electromyographic (EMG) activity of extrinsic muscles of 18 healthy males. Three-dimensional kinematic and kinetic data were obtained via video analysis of surface markers and a force plate. Ankle joint moments are described about orthogonal axes in a segm...
journal_title:Foot & ankle international
pub_type: 临床试验,杂志文章
doi:10.1177/107110070102200105
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Tarsal tunnel pressure is increased when the foot and ankle are positioned in eversion or inversion from neutral, aggravating symptoms of tarsal tunnel syndrome in some patients. Space-occupying lesions may cause tarsal tunnel syndrome. We hypothesized that positional change of the foot and ankle from neutra...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110070602700608
更新日期:2006-06-01 00:00:00
abstract::An intramedullary fixation device was devised by the senior author (K.A.J.) to use in conjunction with a previously described method for tibiotalocalcaneal arthrodesis. Satisfactory results were obtained in approximately 87% of the initial 30 patients; union was radiographically or clinically evident in all but two pa...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110079401501208
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Limited ankle joint dorsiflexion passive range of motion (PROM) has been associated with common chronic lower extremity conditions, and clinicians often instruct patients in stretching exercises to increase dorsiflexion. However, little is known about how subtalar joint (STJ) position affects dorsiflexion at...
journal_title:Foot & ankle international
pub_type: 杂志文章,随机对照试验
doi:10.1177/1071100713513433
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:The Krackow locking loop technique has been used for Achilles tendon repair with documented success in allowing early range of motion with stable fixation. Previous studies documented failure at the rupture site by knot failure. We propose a modification of the traditional Krackow technique where the knots o...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.3113/FAI-2009-0410
更新日期:2009-05-01 00:00:00
abstract::Compartment syndrome of the newly discovered calcaneal compartment of the foot is a theoretical possibility following tibial fracture due to the communication with the deep posterior compartment of the calf. Forty-nine patients were reviewed at least 18 months after open or closed tibial shaft fractures treated with t...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110070102200206
更新日期:2001-02-01 00:00:00
abstract::Achilles tendinosis is a degenerative overuse tendinopathy involving the primary ankle plantarflexors, namely the soleus and gastrocnemius muscles forming the tendo Achilles. The Orthopaedic Research Institute-Ankle Strength Testing System (ORI-ASTS) was designed to record objective measurements of force generated wit...
journal_title:Foot & ankle international
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1177/107110070202300206
更新日期:2002-02-01 00:00:00
abstract:BACKGROUND:Osteonecrosis of the talus is a well-recognized pathology, which can result in significant hindfoot collapse resulting in poor function and pain. Treatment with intramedullary tibiotalocalcaneal arthrodesis (IMTCA) using a retrograde intramedullary nail is widely utilized for severe concomitant tibiotalar an...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/1071100714558506
更新日期:2015-03-01 00:00:00
abstract::Traumatic injuries to the midtarsal joint are quite uncommon and usually involve fractures of adjacent bones. Pure dislocations without fracture are very rare. A patient sustained a pure dislocation that was treated with a nonweight-bearing cast for six weeks, but she went on to present with chronic subluxation at the...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/107110070202300312
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:The time at which patients typically present with surgical site infections (SSI) following foot and ankle surgery has not been characterized. The primary aim of this study was to quantify the time to definitive treatment of SSIs. METHODS:We performed a retrospective review of 1933 foot and ankle procedures ...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/1071100718777468
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:This study was performed to investigate anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis and to investigate whether the severity of preoperative equinus deformity affected the occurrence of symptomatic anterior impingement...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/1071100713488092
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Sufficient inter-fragmentary compression is helpful to achieve successful bony fusion in hindfoot arthrodesis using internal fixation by screws. Beside bone quality, the design of a screw influences inter-fragmentary compression. Compressive force is achievable for any kind of screw system; however, the prim...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.3113/FAI.2008.0225
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:Along with the recent advances in the pharmacological management of rheumatoid arthritis, there is a trend toward the use of joint-preserving surgery in the treatment of rheumatoid forefoot deformities. However, the clinical outcomes of joint-preserving surgery for rheumatoid forefoot deformities have not be...
journal_title:Foot & ankle international
pub_type: 杂志文章
doi:10.1177/1071100715609981
更新日期:2016-03-01 00:00:00