Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Total ankle replacement (TAR) has evolved significantly in the past two decades, yet comprehensive long-term projections of procedural volume and economic impact remain absent from the literature. While extensive projection studies exist for hip, knee, and elbow arthroplasty, the future landscape of TAR utilization remains undefined. Medicare data provides a unique opportunity to model future trends in this rapidly evolving procedure. This study analyzes comprehensive Medicare data (2000-2022) to project TAR and revision TAR (rTAR) volumes through 2040, providing critical insights for workforce planning, healthcare resource allocation, and policy development during a period when foot and ankle specialists may face increasing procedural demand.
Methods:
We analyzed the complete Medicare Part-B National Summary data (2000-2022), determining procedure volumes for primary TAR and rTAR using CPT codes. Volumes were adjusted to account for the rapidly expanding Medicare Advantage population as well, creating adjusted volumes that reflect total Medicare beneficiary utilization. All payments were standardized to 2022 CPI values to enable accurate financial projections. Two complementary statistical approaches were employed to ensure projection reliability: linear regression with natural splines and generalized additive models with thin plate spline smoothers. Both methods generated robust projections with 95% forecast intervals (FI) through 2040. The revision burden was calculated as the rTAR:TAR ratio for each projected year.
Results:
TAR volume increased from 510 procedures in 2000 to 4,893 in 2022 (859% growth). rTAR increased from 52 to 563 procedures (983% growth) over the same period. The projected annual growth rates for primary TAR and rTAR are 3.76% (95% CI: 3.21%-4.32%) and 5.41% (95% CI: 4.74%-6.09%), respectively. By 2040, primary TAR volume is projected to increase 124% from 9,812 procedures in 2023 to 21,971 (95% FI: 19,593-24,350), with an average annual increase of 715 procedures. Revision TAR volume is projected to grow 146% from 1,149 cases in 2023 to 2,827 (95% FI: 2,649-3,005). Annual Medicare spending on primary TARs is projected to reach $3.0 million by 2040, while rTAR expenditure will approach $751,108. The revision burden is projected to increase from 11.7% to 12.9%.
Conclusion:
Our models forecast substantial growth in both primary and revision TAR procedures through 2040. Unlike hip and knee arthroplasty approaching market saturation, TAR represents an emerging procedure with significant growth potential. These findings have critical implications for: (1) Workforce development—specialized training must expand by approximately 35%; (2) Healthcare systems—facilities must prepare for doubling procedure volumes; (3) Implant development—manufacturers should anticipate increased demand for revision systems; and (4) Medicare policy—reimbursement structures require recalibration to maintain access during this growth phase in ankle replacement procedures.
Projected TAR and rTAR Volumes and Medicare Expenditures (2023-2040)