Original Research| Volume 49, ISSUE 3, P242-247, May 2010

Arthroscopic versus Open Ankle Arthrodesis: A Retrospective Cost Analysis


      Compared with traditional open arthrodesis, arthroscopic ankle arthrodesis has been associated with similar rates of fusion, decreased time to union, decreased pain, shorter hospital stay, earlier mobilization, reliable clinical results, and fewer complications. The aim of this case-control study was to analyze cost differences between outpatient arthroscopic and inpatient open ankle arthrodesis. To this end, the authors analyzed 20 ankle arthrodesis procedures: 10 performed by one surgeon on an inpatient basis using an open approach, and 10 performed by another surgeon on an outpatient basis arthroscopically. Patient age, body mass index, tourniquet time, length of stay, complications, days to clinical union, and insurance type, as well as charges and reimbursements for the surgeons and the hospital or surgery center were abstracted from the records. Statistically significant differences were observed between the outpatient arthroscopic and inpatient open arthrodesis groups for total site charges ($3898 ± 0.00 versus $32,683 ± $12,762, respectively, P < .0001), reimbursement to the surgeon ($1567 ± $320 versus $1107 ± $278, respectively, P = .003), and reimbursement to the hospital or ambulatory surgery center ($1110 ± $287 versus $8432 ± $2626, respectively); the ratio of hospital/surgery center charges to hospital/surgery center reimbursements was 28.48% for the inpatient arthroscopic group and 25.80% for the inpatient open arthrodesis group. Outpatient arthroscopic ankle arthrodesis, compared with inpatient open ankle arthrodesis, appears to be less expensive for third party payers, and surgeons are paid more, whereas hospitals and ambulatory surgical centers get paid a greater proportion of the charges that they bill.

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        • Coester L.M.
        • Saltman C.L.
        • Leapold J.
        • Pontarelli W.
        Long-term results following ankle arthrodesis for post-traumatic arthritis.
        J Bone Joint Surg Am. 2001; 83: 219-228
        • Buck P.
        • Morrey B.F.
        • Chao E.Y.
        The optimum position of arthrodesis of the ankle.
        J Bone Joint Surg Am. 1984; 69: 1052-1062
      1. Schneider, D. Arthroscopic ankle fusion. Arthroscopic Video J. 3:1983.

        • O'Brien T.S.
        • Hart T.S.
        • Shereff M.J.
        • Stone J.
        • Johnson J.
        Open versus arthroscopic ankle arthrodesis: a comparative study.
        Foot Ankle Int. 1999; 20: 368-374
        • Stone J.W.
        Arthroscopic ankle arthrodesis.
        Foot Ankle Clin. 2006; 11 (8, vi-vii): 361
        • Collman D.R.
        • Kaas M.H.
        • Schuberth J.M.
        Arthroscopic ankle arthrodesis: factors influencing union in 39 consecutive patients.
        Foot Ankle Int. 2006; 27: 1079-1085
        • Winson I.G.
        • Robinson D.E.
        • Allen P.E.
        Arthroscopic ankle arthrodesis.
        J Bone Joint Surg Br. 2005; 87: 343-347
        • Kats J.
        • van Kampen A.
        • de Waal-Malefijt M.C.
        Improvement in technique for arthroscopic ankle fusion: results in 15 patients.
        Knee Surg Sports Traumatol Arthrosc. 2003; 11: 46-49
        • Dent C.M.
        • Patil M.
        • Fairclough J.A.
        Arthroscopic ankle arthrodesis.
        J Bone Joint Surg Br. 1993; 75: 830-836
        • Gougoulias N.E.
        • Agathangelidis F.G.
        • Parsons S.W.
        Arthroscopic ankle arthrodesis.
        Foot Ankle Int. 2007; 28: 695-706
        • Ferkel R.D.
        • Hewitt M.
        Long-term results of arthroscopic ankle arthrodesis.
        Foot Ankle Int. 2005; 26: 275-280
        • Ogilvie-Harris D.J.
        • Lieberman I.
        • Fitsialos D.
        Arthroscopically assisted arthrodesis for osteoarthrotic ankles.
        J Bone Joint Surg Am. 1993; 75: 1167-1174
        • Zvijac J.E.
        • Lemak L.
        • Schurhoff M.R.
        • Hechtman K.S.
        • Uribe J.W.
        Analysis of arthroscopically assisted ankle arthrodesis.
        Arthroscopy. 2002; 18: 70-75
        • Cameron S.E.
        • Ulrich P.
        Arthroscopic arthrodesis of the ankle joint.
        Arthroscopy. 2000; 16: 21-26
        • Nielsen K.K.
        • Linde F.
        • Jensen N.C.
        The outcome of arthroscopic and open surgery ankle arthrodesis: A comparative retrospective study on 107 patients.
        Foot Ankle Surgery. 2008; 14: 153-157
        • Myerson M.S.
        • Quill G.
        Ankle arthrodesis. A comparison of an arthroscopic and an open method of treatment.
        Clin Orthop Relat Res. 1991; 268: 84-95
        • Jerosch J.
        • Steinbeck J.
        • Schroder M.
        • Reer R.
        Arthroscopically assisted arthrodesis of the ankle joint.
        Arch Orthop Trauma Surg. 1996; 115: 182-189
        • Lee M.S.
        • Millward D.M.
        Arthroscopic Ankle Arthrodesis.
        Clinics of Podiatric Medicine and Surgery. 2009; 26: 273-282
        • Monroe M.T.
        • Beals T.C.
        • Manoli 2nd, A.
        Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws.
        Foot Ankle Int. 1999; 20: 227-231
        • Mann R.A.
        • Van Manen J.W.
        • Wapner K.
        • Martin J.
        Ankle Fusion.
        Clin Orthop Relat Res. 1991; 268: 49-55
        • Glick J.M.
        • Morgan C.D.
        • Myerson M.S.
        • Sampson T.G.
        • Mann J.A.
        Ankle arthrodesis using an arthroscopic method: long-term follow-up of 34 cases.
        Arthroscopy. 1996; 12: 428-434
        • Stetson W.B.
        • Ferkel R.D.
        Ankle arthroscopy: II. Indications and results.
        J Am Acad Orthop Surg. 1996; 4: 24-34