Comparisons of initial outcomes and cost-effectiveness after total ankle arthroplasty versus bipolar osteochondral allograft transplantation in the ankle: a retrospective cohort study

Background: Total ankle arthroplasty (TAA) has been a standard-of-care surgical treatment option for patients who are suffering from ankle disorders since the 1960s. It is costly with a limited lifespan; younger, active patients will likely need additional surgeries. Evidence-based advancements in osteochondral allograft (OCA) preservation and transplantation techniques have resulted in improved outcomes, making it a potentially more appropriate treatment option for specific patients. This study compares 90-day clinical and self-reported outcomes for patients who received TAA or bipolar OCA ankle transplantation. Methods: Differences in costs and quality-adjusted life years (QALY) for patients were determined using postoperative 1-year follow-up. An institutional review board-approved review of electronic medical records and billing data was conducted for patients who underwent TAA or bipolar OCA ankle transplantation (n=35) at a single institution between 2014 and 2018. Postoperative patient-reported outcome scores and cost comparisons were completed using a two-sample t -test, or nonparametric alternative, or chi-square test. Results: Three months after surgery, no statistically significant differences in patient-reported outcomes, postsurgical complications, or value-based care metrics were observed between older TAA (n=18) or younger OCA groups (n=17). Based on data, OCA and TAA were both considered cost-effective treatment options; differences in the incremental cost-effectiveness between OCA and TAA were not statistically significant ( P =0.99), and 1-year outcomes were good to excellent. Conclusions: These results will guide more robust planning for 90-day postoperative reimbursement guidelines. Ongoing work is needed to assess mid-term and long-term outcomes for patients with respect to morbidity, complications, patient-reported outcomes, costs, and QALY. Level of Clinical Evidence: Level III.