FAI August 2026 Podcast: Long-term Outcomes After First Metatarsophalangeal Joint Arthrodesis: With Focus on Degenerative Changes on Adjacent Joints

First metatarsophalangeal joint arthrodesis is a reliable treatment for painful end-stage degenerative, inflammatory, and post-traumatic conditions and severe deformities of the first ray. Although long-term functional outcomes are well documented, the incidence and relevance of degenerative changes in adjacent joints of the medial column after first metatarsophalangeal joint (MTP1) fusion remain uncertain. In conclusion, MTP1 arthrodesis provides excellent long-term satisfaction and functional outcomes with low revision rates. Although radiographic adjacent-joint degeneration, particularly involving the interphalangeal joint, may occur over time, these changes do not appear to influence clinical outcomes.

Supramalleolar osteotomy (SMO) enables deformity correction of the distal tibia, but the procedure remains technically demanding. Patient-specific instruments (PSIs) have the potential to mitigate the technical drawbacks associated with SMO that are performed free-hand, but their accuracy has not been investigated. Therefore, we aimed to perform a pre- vs post-operative comparison to assess the accuracy of PSI in the setting of SMO correction. In conclusion,This study demonstrated an accurate correction of distal tibia deformities by SMO using PSIs. The achieved post-operative correction differed within the range of 1° from the pre-operatively simulated correction. This indicates that PSIs provide a precise execution of the pre-operative planning. Future studies should assess the added value of performing an SMO with PSI compared with former free-hand techniques towards clinical and radiographical outcomes. Click here to read the article

Conflicting evidence exists regarding the ability of surgical helmet systems (SHSs) to reduce rates of infection after joint replacement. The purpose of this study was to investigate the use of SHS in total ankle arthroplasty (TAA) and their effect on postoperative infection rates. In conclusion, Although SHS may provide additional protection for the surgeon from being contaminated during the surgery, the use of surgical hoods was not associated with a protective effect against surgical site infection. Considering the disadvantages and added costs of SHS, the decision to wear hoods during TAA is therefore left to the individual surgeon's discretion and personal preference. Click here to read the article

As total ankle arthroplasty (TAA) use evolves, understanding implant longevity and survivorship expectations has become critical for patient counseling and decision making. The purpose of this study was to determine the long-term survivorship of the INBONE II TAA. In Conclusion, ten-year survivorship of INBONE II TAA was 93% in this cohort. Despite periprosthetic osteolysis and/or peri-implant lucency, the reoperation rate was low. Although the small number of failures prevented statistically significant conclusions, radiographic patterns suggest possible higher risk of failure in those with greater varus deformity. Click here to read the article.

Total ankle arthroplasty (TAA) is increasingly used as a motion-preserving alternative to ankle arthrodesis for end-stage ankle disease. The Salto Talaris fixed-bearing prosthesis was designed to enhance joint kinematics while minimizing bone resection and reducing complications seen in earlier implant generations. This study reports midterm clinical outcomes, including survivorship, complications, reoperation and failure rates in a large, single-surgeon cohort. In conclusion, in this large cohort, the Salto Talaris TAA was associated with improvements in patient-reported quality of life, activity, and pain, and showed high survivorship with relatively low failure (5.4%) and reoperation (12.0%) rates at an average of 5.5 years after index surgery.   Click here to read the article.

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.