JAAOS - 2026-07-15 - Journal Article; Comparative Study
Is Total Ankle Arthroplasty Adequately Compensated? A Propensity Score-matched Comparison of Work Relative Value Units With Other Joint Arthroplasties.
Lachance AD, Sun P, Lee W
Topics
Key Takeaway
TAA generates 7.17 wRVU/hour versus 13.84, 13.13, and 15.86 wRVU/hour for TKA, THA, and TSA respectively, despite requiring 135.69 minutes of operative time compared to roughly 92–97 minutes for the other three procedures.
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Summary
This study used NSQIP data (2020–2022) to compare wRVU/hour and reimbursement rates for TAA versus TKA, THA, and TSA after 1:1 propensity score matching by age and sex. TAA required significantly longer operative time (135.69 vs. ~92–97 min) yet yielded substantially lower wRVU/hour (7.17 vs. 13.13–15.86) and reimbursement (231.77 vs. 424.73–513.12 $/hour). These compensation disparities persisted after adjusting for preoperative comorbidities and 30-day complication rates.
Key Limitation
NSQIP does not capture surgeon volume or fellowship training, so the longer TAA operative times may reflect lower-volume or less-experienced centers rather than the intrinsic procedural demand, potentially overstating the compensation gap at high-volume practices.
Original Abstract
BACKGROUND
Total ankle arthroplasty (TAA) is among the most technically demanding joint arthroplasties; however, the adequacy of its compensation has not been thoroughly examined. Work relative value units (wRVUs), a key metric for physician reimbursement, are assigned based on the complexity and time associated with clinical activities. This study aims to evaluate whether TAA is adequately compensated compared with total knee arthroplasty (TKA), total hip arthroplasty (THA), and total shoulder arthroplasty (TSA), using the National Surgical Quality Improvement Program (NSQIP) database.
METHODS
Arthroplasty procedures, including TAA, TKA, THA, and TSA, were identified using Current Procedural Terminology codes within the NSQIP database from 2020 to 2022. A 1:1 propensity score matching was done using the TAA group as the reference, matched across groups by age (±1 year) and sex. The adequacy of TAA compensation was assessed based on wRVUs, surgical time (OT), wRVUs per hour (wRVU/hour), and reimbursement rates ($/hour), in comparison to other joint arthroplasties. Postoperative complications within 30 days were evaluated to compare procedural risk profiles.
RESULTS
After propensity score matching, 511 cases were identified per group. TAA was associated with a markedly longer surgical time compared with other joint arthroplasties (TKA, THA, TSA): 135.69 versus 91.66, 97.82, and 96.77 minutes, respectively ( P < 0.001). In addition, TAA demonstrated a markedly lower mean wRVU/hour (7.17 versus 13.84, 13.13, and 15.86, respectively; P < 0.001) and reimbursement rate (231.77 versus 447.81, 424.73, and 513.12 $/hour, respectively; P < 0.001). These trends remained consistent after adjusting for preoperative comorbidities and postoperative complication rates.
CONCLUSIONS
Despite requiring markedly longer OT, TAA was associated with substantially lower wRVU/hour and reimbursement rate. Our results suggest that the current wRVU scale may inadequately compensate for TAA, particularly in comparison to other joint arthroplasty procedures. These findings highlight the potential need to reevaluate wRVU allocation for TAA to ensure more equitable and appropriate compensation.
LEVEL OF EVIDENCE
Level III.