Trends & Demographics of Ankle Arthroscopy
in the United States
Jonathan Godin, MD, MBA, R. Andrew Henderson, MD, MSc,
Benjamin Streufert, BS, Selene Parekh, MD, MBA, Samuel
Adams, MD
Duke University Medical Center
Department of Orthopaedic Surgery
Disclosures
• None
Background
• Ankle arthroscopy
– Detection & treatment
– Procedures evolving
– Indications increasing
– Outcomes data
• Purpose
– Evaluate the trends
– Report demographics
Methods
• Ankle arthroscopy 2007 – 2011
– Identified by searching CPT codes in the PearlDiver Patient
Records Database
• Dataset w/ 633M records (20M patients)
– 29891: Arthroscopic excision of osteochondral defect
– 29892: Repair of osteochondritis dissecans lesion of talar
dome or tibial plafond fracture
– 29894: Loose body or foreign body removal
– 29895: Partial synovectomy
– 29897: Limited debridement
– 29898: Extensive debridement
Results: Incidence by Age Group
•
•
•
•
•
13,452 patients
Total patients treated increased 11.3%
Overall incidence: 7.6% increase from 4.24 in 2007 to 4.56 in 2011
15 to 19 yo: highest incidence at 0.78 procedures per 10,000
Highest growth in incidence: 10 to 14 yo (22.6% increase)
Results: Incidence by Gender
• 7,252 female and 6,201 male patients (p=0.093)
• 12% increase in incidence in females (p=0.05)
Results: Arthroscopic Procedures
• 1st - Extensive debridement (CPT-29898)
• 2nd - Excision of osteochondral defect (CPT-29891)
• Most common diagnosis: OCD (19.3% of cases)
Results: Associated Procedures
• Fluoroscopy: 8.5%
• Ultrasound guidance: 8.3%
Results: Pre-operative Imaging
• During the year prior to arthroscopic intervention:
– Ankle radiographs: 64%
– MRI: 51%
Results: Incidence by Region
• West
– Highest incidence of treatment at 0.57 procedures per 10,000 in 2011
– Number of patients treated significantly greater than other regions
(p<0.001)
– Largest increase in incidence from 2007 to 2011 at 21.0% (p=0.017)
Results: Incidence by Facility Type
• 8,158 patients (60.6%) at outpatient hospitals
• 5,036 patients (37.4%) at ambulatory surgery
centers
Results: Complications
• Most commonly reported
complication within 30 days
– Infection or wound complications
• Total prevalence of 1 in 76
patients
– Cellulitis: 1.03%
– Pyogenic arthritis: 0.21%
• Acute post-operative pain: 0.25%
• DVT: 0.16%
• 6 months
– Fewer than 11 cases of nontraumatic compartment
syndrome or nerve injury
Discussion/Conclusions
• 7.6% increase in the incidence of ankle arthroscopy
• 15 to 19 yo – most common
– Slight female gender predilection
• Western region of US
– Higher incidence of ankle arthroscopy
• Ankle arthroscopy
– Most commonly performed in outpatient hospital setting
Next Steps
• Further research: why regional
differences exist
• Explore reasoning for lack of preoperative imaging on all patients
• Improved assessment & analysis
of charge variation
• Use of data to define and
improve the value of
musculoskeletal care
• Translate the results to impact
policy & payors