2025 AOFAS Annual Meeting-Paper Session 4B, Symposium 9B, Symposium 10B, Paper Session 5B, Symposium 11B

Video Transcription

Video Summary

The session provided comprehensive insights into total ankle arthroplasty (TAA), encompassing compensation disparities, surgical techniques, imaging challenges, biologic adjuncts, and management of complications. Key presentations included:<br /><br />1. Andrew LaChance highlighted that total ankle arthroplasty, despite being technically demanding with longer operative times, is inadequately compensated compared to hip, knee, and shoulder arthroplasties based on work relative value units (WRVU) and reimbursement rates. Outcomes and complication rates were comparable across these joints, underscoring a need to reexamine WRVU allocation for equitable compensation.<br /><br />2. Kevin Schaffer presented the largest series analyzing fibular osteotomy healing in transfibular TAA. Healing rates were high (99% at 12 months) with very low nonunion rates (~1%), unaffected by age, diabetes, or smoking. Techniques such as bone grafting and bone marrow aspirate concentrate may enhance healing.<br /><br />3. Cody discussed using 18F sodium fluoride PET-CT scans in asymptomatic TAA patients, revealing elevated bone metabolic activity around implants persisting up to 24 months postoperatively. This necessitates caution when interpreting radionuclide bone scintigraphy within two years after surgery.<br /><br />4. Ken Hunt demonstrated the utility of AI, specifically large language models, to automate registry data collection of TAA complications, significantly enhancing efficiency while maintaining sensitivity and specificity comparable to manual chart reviews, albeit with some false positives.<br /><br />5. Wanyong Lee analyzed Work RVUs for fracture fixation surgeries, revealing ankle fracture fixation is undervalued relative to hip and distal radius fractures due to longer operative times but lower compensation rates.<br /><br />6. J. Leonard Goldner compared patient-specific instrumentation (PSI) to traditional jigs in InBone2 TAA, showing similar accuracy in implant alignment but longer operative times with PSI, possibly reflecting surgeon preferences.<br /><br />7. Dan Guss and Lou Go discussed peroneal tendon pathologies, emphasizing mechanical considerations, imaging pitfalls (magic angle effect in MRI), and biologic adjuncts like PRP and BMAC, with mixed evidence for their efficacy.<br /><br />8. Bobby Undu reviewed management of recurrent peroneal dislocations, favoring soft tissue repair of the superior peroneal retinaculum over groove deepening for most patients except high-level athletes.<br /><br />9. Caitlin Neary addressed irreparable peroneal tendon tears, comparing tenodesis and allograft reconstruction. Both are viable options; allografts may better restore native biomechanics but clinical consensus is lacking.<br /><br />10. Several talks highlighted challenges in revising failed hallux valgus surgery, functional hallux rigidus treatments including first metatarsal shortening osteotomy, and juvenile bunion corrections, stressing meticulous preoperative planning and managing patient expectations.<br /><br />11. Thelma Jimenez presented systematic reviews on stemmed and non-stemmed TAA implants, demonstrating favorable mid-to long-term outcomes and survivorship (~80-90% at 10 years) for both, with loosening being a common complication.<br /><br />12. Agustin Barbero analyzed medial column alignment adaptation post-TAA via weight-bearing CT, showing significant adaptation but no correlation between hindfoot and medial column changes, highlighting complex biomechanics.<br /><br />13. Grant Thomas showcased early experience with custom 3D-printed short-stem tibial trays in complex revision TAA, reporting satisfactory short-term outcomes and stable radiographic alignment.<br /><br />14. Marianne Kulin demonstrated that subtalar osteoarthritis causes disability comparable to ankle osteoarthritis, reinforcing the importance of recognizing hindfoot pathology.<br /><br />15. Experienced surgeons Steven Haddad, Keith Wapner, and Selene Parekh shared valuable lessons highlighting principles from architecture applied to TAA stability, the importance of balancing the foot and ankle biomechanics, patient optimization, meticulous surgical planning, team coordination, wound care innovations, and individualized postoperative rehabilitation.<br /><br />Overall, the session emphasized advancing surgical techniques, accurate assessment, patient-centered care, and system-level improvements in compensation and complication tracking to optimize outcomes in total ankle arthroplasty and related foot and ankle pathologies.

Keywords

total ankle arthroplasty

TAA compensation disparities

surgical techniques in TAA

fibular osteotomy healing

transfibular TAA

18F sodium fluoride PET-CT

bone metabolic activity

AI in complication tracking

work RVU valuation

patient-specific instrumentation

peroneal tendon pathologies

recurrent peroneal dislocations

irreparable peroneal tendon tears

hallux valgus revision

custom 3D-printed tibial trays