La protesi di caviglia: analisi delle Schede di Dimissione Ospedaliera 2001-2023 con focus sugli istituti ad alto volume di attività

Ankle prosthesis in Italy: a growing surgical option supported by high-volume centres. Analysis based on the national Hospital Discharge Record database for the period 2001-2023 Introduction Total ankle replacement (TAR) is a growing procedure for the treatment of advanced osteoarthritis, a condition that causes pain and disability. Traditionally treated with fusion, TAR is becoming a viable alternative due to the introduction of new and more efficient generations of implants. This study analyses the trends in TAR in Italy from 2001 to 2023, focusing on high-volume hospitals and interregional patient mobility flows. Materials and methods Records identified as TAR in the Hospital Discharge Record database were aggregated by year, region and health facility. Statistical significance of time series trends was assessed using the Cox-Stuart test with randomness as the null hypothesis. Attraction/escape indices were calculated for regions with the highest number of procedures. Results A total of 9,858 TARs were performed from 2001 to 2023, with a significant annual increase and a higher prevalence among males. Lombardy and Emilia-Romagna regions account for 65% of the national volume in 2023, attracting several patients from other regions. Contribution of high-volume centres increased from 3.1% in 2001 to 45.5% in 2023. Discussion and conclusions An expansion of high-volume health facilities was observed, together with an increase in TAR and interregional patient mobility. We hope that these analyses will help policymakers to ensure more equal access to healthcare. The implementation of the national registry will make it possible to monitor outcomes across the country.