Total Ankle Replacement

In this episode, Marc and Mo are joined by special guest Bruce Sangeorzan—Professor of Orthopaedics at the University of Washington and world-renowned foot and ankle researcher—in a lively discussion on the past, present, and future of ankle replacement.  

• Approximately 700,000 knee replacements are performed each year, compared with just 10,000-20,000 ankle replacements, leading to a number of questions:
  • How does this factor affect the number of clinicians who are as skillful and comfortable in performing ankle replacement as compared with shoulder, knee, and hip replacement?
  • How do better-designed alignment devices, improved implants, and better training affect the numbers of ankle replacements being performed each year?
  • How soon can we reach 40,000 ankle replacements each year?
• What are the challenges in performing RCTs of ankle arthroplasty? Is an RCT even the right study design for this topic?
• What design elements seem to be most successful, especially given the space limitations in the ankle region?
• How do factors such as degenerative disease, BMI, activity level, and adjacent osteotomy affect the results of ankle replacement and arthrodesis? 

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Resources/Links:

• Veljkovic AN, Daniels TR, Glazebrook MA, Dryden PJ, Penner MJ, Wing KJ, Younger ASE. Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis. J Bone Joint Surg Am. 2019 Sep 4;101(17):1523-1529. doi: 10.2106/JBJS.18.01012. PMID: 31483394. https://jbjs.org/reader.php?id=205473&rsuite\_id=2159103&native=1&source=The\_Journal\_of\_Bone\_and\_Joint\_Surgery/101/17/1523/fulltext&topics=fa#info  
• Muller P, Skene SS, Chowdhury K, Cro S, Goldberg AJ, Doré CJ; TARVA Study Group. A randomised, multi-centre trial of total ankle replacement versus ankle arthrodesis in the treatment of patients with end stage ankle osteoarthritis (TARVA): statistical analysis plan. Trials. 2020 Feb 18;21(1):197. doi: 10.1186/s13063-019-3973-4. PMID: 32070409; PMCID: PMC7029552. https://pubmed.ncbi.nlm.nih.gov/32070409/ 
• The Canadian Foot and Ankle Society (COFAS): https://coa-aco.org/foot-ankle-cofas/ 

Brought to you by Mohit Bhandari and Marc Swiontkowski of OrthoJOE.