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?  OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to [email protected] 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.