Trends Among High-Volume Total Ankle Arthroplasty Surgeons

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: This study aims to analyze the trends in distribution and temporal changes of total ankle arthroplasty (TAA) surgeons by gender, degree, and settlement type. Methods: Data from the Medicare Provider Utilization and Payment Data from 2013-2021 was used to identify orthopaedic surgeons conducting primary total ankle arthroplasty (current procedural terminology [CPT] code 27702). Surgeons performing at least 11 surgeries on Medicare patients annually under this code were included, providing details regarding gender, credentials, practice location, and National Provider Identifier (NPI). This dataset was cross-referenced with the Medicare Physician Compare dataset to gather information on hospital affiliations and year of medical school graduation. Results: The number of surgeons performing at least 11 TAAs annually increased from 31 in 2013 (1 female; 30 MD/ 1 DPM/ 0 DO) to 40 (0 females, 35MD/3 DPM/ 2 DO) in 2021, only 2 females were present throughout study years. When excluding these 2020 and 2021 (due to the COVID-19 pandemic), the number of cases annually grew significantly at a rate of 49 cases per year (β=49.14) and providers at a rate of 2.5 per year (β=2.5), though the distribution of providers was not found to change significantly. Additionally, it was found that MDs were in practice significantly longer than DOs and DPMs, as measured by graduation year (MD=1991, DO=2000, DPM=1998), and on average had significantly more cases per year (MD=16.97, DO=12, DPM=14.23; p=.025). Conclusion: From 2013 to 2021 there has been an increase in the number of providers among TAA surgeons. However, the representation of female high volume TAA surgeons is exceptionally lagging. Sustained initiatives aimed at enhancing orthopedic advancements and guiding female residents and medical students with an interest in TAA could potentially catalyze significant improvements in the gender imbalances among TAA surgeons in the years ahead.