FAI March 2026 Podcast: Effect of Earlier Weightbearing on Ankle Range of Motion and Complications After Primary Total Ankle Arthroplasty

Total ankle arthroplasty (TAA) is a viable option for the treatment of end-stage ankle arthritis. Initiating weightbearing after a TAA has traditionally been conservative, with anywhere from 6 to 12 weeks of non-weightbearing recommended by surgeons. There is a scarcity of literature examining the impact of earlier weightbearing after TAA on postoperative outcomes. This study aimed to compare weightbearing at 3 weeks vs 6 weeks on functional recovery after primary TAA. We hypothesized that patients allowed to weightbear earlier would exhibit greater improvements in ankle range of motion (ROM) without an increase in postoperative complications. In conclusion, initiating earlier weightbearing after a primary TAA brings about greater improvements in postoperative ankle ROM compared with preoperative ROM, sustained even up to 2 years postoperative. Earlier weightbearing group demonstrated increased ankle ROM compared with the delayed weightbearing group at early follow-up without an increase in complications. These findings suggest earlier initiation of weightbearing after a primary TAA is safe and beneficial in terms of motion.   Click here to read the article.

FAI podcast host, Dr. Mark Easley speaks with Drs. Aiyer, Gross, Rascoe, and Wukich on their recently published papers in FAI January and February issues: Both Tobacco and Non-Tobacco Nicotine Dependence Are Associated With Increased Complications Following Ankle Fracture Open Reduction Internal Fixation: A Propensity-Matched TriNetX Analysis (2005-2025) Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Risks of Infection, Nonunion, and Reoperation Non-Tobacco Nicotine Dependence Is Associated With Increased Risk of Reoperation and Complications After Ankle Fracture ORIF: A Propensity-Matched Database Study Postoperative Outcomes After Ankle Fracture ORIF in Patients With Documented Nicotine and/or Cannabis Use: An Observational Analysis

Is first metatarsophalangeal joint replacement a viable alternative to arthrodesis for the treatment of end-stage hallux rigidus? There are few studies evaluating the medium- to long-term outcomes of the Roto-Glide prosthesis. In conclusion, first metatarsophalangeal joint replacement using Roto-Glide prosthesis results in statistically and clinically significant improvement in patient-reported outcome measures in the medium to long term. We found overall good implant survivorship in the medium term. However, postoperative surgical complications were relatively high. With marked reduction in surgical complications, first MTP joint replacement may be considered an alternative for patients with end-stage hallux rigidus who want to retain joint motion. Further comparative studies with longer-term follow-up are required to compare the outcomes of arthroplasty to arthrodesis, which is considered the gold standard. Click here to read the article.

Although prior ankle or subtalar arthrodesis is thought to affect outcomes at adjacent joints, previous studies have not distinguished between successful and failed prior fusions. This study examines whether prior successful vs failed ipsilateral arthrodesis influences nonunion risk in subsequent ankle or subtalar fusion. The primary objective of this study is to examine nonunion rates after subtalar and ankle arthrodesis in patients with and without prior ipsilateral arthrodesis, and vice versa. In conclusion, our analysis of the TriNetX Research Network database suggests that when the primary ankle or subtalar arthrodesis is successful, performing a subsequent adjacent fusion does not significantly increase the risk of nonunion compared with an isolated fusion. However, failed prior arthrodesis substantially increases nonunion risk, highlighting the importance of distinguishing between successful and failed prior procedures in clinical decision-making. Click here to read the article.

Patient-specific instrumentation (PSI) was developed to improve accuracy and efficiency in implant placement for total ankle arthroplasty (TAA). This study represents the first to measure the accuracy of PSI regarding implant alignment and implant size in the INBONE II total ankle system (Stryker). A secondary goal was to compare radiographic and clinical outcomes between the PSI and that of a matched group of implants performed with standard instrumentation. In conclusion, this study of stemmed TAA implants, surgeons achieved alignment generally consistent with PSI predictions. PSI adequately predicted implant size. For most cases, PSI achieved similar alignment and correction of deformity compared with standard instrumentation. PSI did not improve radiographic alignment compared with traditional instrumentation and was associated with longer operative times, possibly reflecting the primary surgeon's early experience with the technique. Each surgeon should select PSI or the standard jig based on their experience and preference. Click here to read the article.

There is increasing interest in the role of pronation as part of the deformity correction in hallux valgus (HV) especially with the advent of weightbearing computed tomography (WBCT) and percutaneous surgical techniques. This study aimed to assess the coronal rotation of the first metatarsal before and after percutaneous distal transverse osteotomy (Metaphyseal Extra-Articular Transverse and Akin Osteotomy [META]) using WBCT and to correlate these findings with clinical outcome scores. In conclusion, percutaneous distal transverse osteotomy for hallux valgus deformity can significantly correct coronal plane pronation and improve patient-reported outcomes, although correction of pronation was not significantly correlated with clinical improvement. Click here to read the article.  

Bone marrow stimulation (BMS) is the most frequently performed surgical procedure for osteochondral lesions of the talus (OLTs). After the surgical intervention, one of the first goals of rehabilitation is to resume weightbearing. This study aims to compare clinical and radiologic outcomes between immediate weightbearing and delayed weightbearing, which represent unrestricted weightbearing and weightbearing starting at 6 weeks postoperatively. In conclusion, this matched cohort study found no statistically significant difference in clinical or radiologic outcomes at 12 months between immediate and delayed weightbearing following arthroscopic BMS for talar osteochondral lesions. Although early weightbearing may be feasible and well tolerated, the small sample size and wide CIs limit the strength of conclusions. These findings should be considered hypothesis-generating and underscore the need for larger, prospective trials. Click here to read the article

Total ankle arthroplasty (TAA) is a common method of treatment for end-stage ankle arthritis (ESAA). The utilization of Patient-Reported Outcomes Measurement Information System (PROMIS) allows for standardized assessment of patient-driven outcomes, but few studies have been published on outcomes of TAA using PROMIS. The purpose of this study was to describe the recovery trajectory of patients undergoing TAA for ESAA for up to 1 year after surgery using PROMIS scores for physical function (PF), pain interference (PI), and depression (DP). In conclusion, this study demonstrates that patients who underwent primary TAA have improvements in PROMIS scores at several different time points up to 1 year after surgery. Patients can expect an improvement in pain and function from baseline within 3 months from surgery. Most improvements occur within the first 6 months. More than half of the patients will achieve a PF and PI score within 1 SD of the national average by 6 months, but it can take up to a year for most patients to reach this. Understanding the trajectory of patient recovery at different time points after primary TAA can help set patient expectations and guide intervention.   Click here to read the article.

Displaced intraarticular calcaneal fractures (DIACFs) are associated with high rates of posttraumatic arthritis. Traditional management with open subtalar arthrodesis often results in high revision rates and complications. Acute open arthrodesis has shown success in Sanders III and IV calcaneus fractures, with favorable return-to-work and radiographic fusion outcomes. This study evaluates the radiographic results of calcaneus percutaneous reduction and posterior arthroscopic subtalar arthrodesis (C-PASTA) for acute Sanders III and IV fractures. In conclusion, C-PASTA demonstrates excellent fusion rates, significant restoration of calcaneal alignment, and minimal complications. These findings suggest that C-PASTA is a viable, minimally invasive technique for acute Sanders III and IV fractures. Click here to read the article.

The results of the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure for lateral osteochondral lesions of the talus (OLTs) are unknown. Therefore, the present prospective study aims to assess the numeric rating scale (NRS) of pain during walking at 2-year follow-up. Secondarily, the aim is to assess other clinical, radiologic, and safety outcomes. In conclusion, in the first 7 prospectively followed patients who underwent the TOPIC procedure for large osteochondral lesions of the lateral talar dome, an improvement of the NRS of pain during walking from median 5 preoperatively to 1 at 2-year follow-up was observed. Click here to read the article.