Emerging National Trends in Ankle Prosthesis: A 15-Year Analysis of the Italian National Hospital Discharge Records.

ABSTRACT

Total ankle replacement (TAR) has gained popularity in recent years becoming the mainstream treatment for conditions like rheumatoid arthritis, posttraumatic arthritis and severe osteochondral lesions of the talus. The aim of the study was to assess the nationwide number of implants performed in a 15-year period (2001-2016) and to identify trends like patients' interregional migratory flows and their accessibility to this procedure. Data for this study were obtained from the Italian National Hospital Discharge records (SDO), obtained from the National Ministry of Health. The selected SDOs were evaluated for demographic data, like the patient's age and gender, for geographical data, including the region of hospitalization and the region of origin of the patient, and for hospitalization data, like the hospital stay length and the principal source of payment. In a 15-year span, a sharp increase in the number of TARs was observed with a 600% growth. The incidence was 0.16 per 100,000 persons in 2001 and increased to 0.915 per 100,000 persons in 2016. Most TAR were performed in northern Italy (73.9%), followed by central Italy (16.7%) and lastly southern Italy (9.4%). The rates of utilization of TAR increased every year from 2001 to 2016, indicating that demand for ankle arthroplasties is growing faster regarding to other procedures performed in Italy. The surgical cost was covered, in the majority of cases, by the National Health System and may play a role in the rising rates of TAR.