Insurance Status and Patient Outcomes After Total Ankle Arthroplasty

Abstract

Background

As total ankle arthroplasty (TAA) becomes more prevalent compared with arthrodesis for treating ankle osteoarthritis, understanding the impact of insurance type on outcomes is crucial. This retrospective cohort study compares Medicare and Preferred Provider Organization (PPO)/Health Maintenance Organization (HMO) patients, assessing differences in clinical characteristics, complications, reoperations, and patient-reported outcomes. The goal is to identify disparities in TAA outcomes based on insurance type.

Methods

We conducted a retrospective cohort study of 830 patients who underwent TAA between May 2010 and June 2024. Patients were grouped by insurance type (Medicare vs PPO/HMO). The inclusion criteria were patients aged 18+ undergoing TAA; exclusions were for incomplete records. Patient-reported outcomes included preoperative and 1-year postoperative visual analog scale (VAS) pain scores and Foot and Ankle Ability Measure scores. Statistical analyses used T-tests, Mann-Whitney U tests, χ², and Fisher exact tests.

Results

The study analyzed 830 participants, with 401 in the Medicare cohort and 429 in the PPO/HMO cohort. Medicare patients were older (mean 70.4 years vs 59.1 years, P < .001), had a higher Charlson Comorbidity Index (3.72 vs 2.51, P < .001), and experienced longer lengths of stay (1.73 vs 1.44 days, P < .001). Prior ankle surgery was more common in the PPO/HMO cohort (49.9% vs 41.4%, P = .017). Preoperative VAS pain scores were significantly higher in the PPO/HMO cohort (6.70 vs 5.91, P = .021), whereas postoperative VAS scores were similar between groups (P = .100). There were no significant differences in reoperation, readmission, or return to normal activities between the cohorts.

Conclusion

Insurance type is associated with differences in patient demographics and preoperative characteristics among patients undergoing TAA. Despite higher comorbidity burden and longer hospital stays among Medicare patients, postoperative clinical outcomes and functional recovery were comparable between Medicare and PPO/HMO cohorts.

Level of Evidence

III—Retrospective Comparative Study