Primary total ankle replacement surgery is a cost-effective intervention

Zach J Place, Deborah J Macdonald, Nicholas D Clement, Hisham Shalaby, John C McKinley

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

AIMS: The primary aim was to assess the cost-effectiveness of primary total ankle replacements (PTAR) in the UK. Secondary aim was to identify predictors associated with increased cost-effectiveness of PTAR.

METHODS: Pre-operative and six-month post-operative data was obtained over a 90-month period across the two centres receiving adult referrals in the UK. The EuroQol general health questionnaire (EQ-5D-3L) measured health-related Quality of Life (HRQoL) and the Manchester-Oxford Foot Questionnaire (MOXFQ) measured joint function. Predictors, tested for significance with QALYs gained, were pre-operative scores and demographic data including age, gender, BMI and socioeconomic status. A cost per QALY of less than £20,000 was defined as cost effective.

RESULTS: The 51-patient cohort [mean age 67.70 (SD 8.91), 58.8% male] had 47.7% classed as obese or higher. Cost per QALY gained was £1669, rising to £4466 when annual (3.5%) reduction in health gains and revision rates and discounting were included. Lower pre-operative EQ-5D-3L index correlated significantly with increased QALYs gained (p < 0.01), all other predictors were not significantly (p > 0.05) associated with QALYs gained.

CONCLUSIONS: PTAR is a cost-effective intervention for treating end-stage ankle arthritis. Pre-operative EQ-5D-3L was associated with QALYs gained. A pre-operative EQ-5D-3L score of 0.57 or more was not cost effective to operate on.

Original languageEnglish
Article number101830
JournalThe Foot
Early online date15 Sept 2021
Publication statusPublished - Dec 2021

Keywords / Materials (for Non-textual outputs)

  • Aged
  • Arthroplasty, Replacement, Ankle
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Male
  • Quality of Life
  • Quality-Adjusted Life Years
  • Surveys and Questionnaires


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