What’s New in Foot and Ankle Surgery 2023

Long-term survivorship of total ankle arthroplasty, rerupture rates associated with the treatment of acute Achilles tendon rupture, and other important findings are presented in the new JBJS Guest Editorial “What’s New in Foot and Ankle Surgery.” Here, we highlight the 5 most impactful studies, as selected by co-author Walter C. Hembree, MD. 

Pes Planus 

The diagnostic reliability of a new classification for progressive collapsing foot deformity was assessed in a survey of trainees, graduates, and faculty across 13 foot and ankle fellowship programs¹. The overall diagnostic accuracy rate was 71.0%; the stage diagnostic accuracy rate, 81.7%; and the class diagnostic accuracy rate, 78.3%. Misdiagnosis rates were 3.3% for class A, 17.5% for class B, 11.1% for class C, 26.0% for class D, and 3.7% for class E. As noted by the study authors, further content validation is needed for the classification scheme, particularly for classes with low diagnostic accuracy.  

Achilles Rupture and Tendinosis 

A Level-I systematic review and meta-analysis evaluated complication rates following operative and nonoperative treatment of acute Achilles tendon ruptures and included a “best-case scenario” and “worst-case scenario” analysis of rerupture rates (with “best-case” assuming a 0% rerupture rate and “worst-case,” a 100% rerupture rate among patients lost to follow-up)². The researchers found that operative treatment significantly reduced the risk of rerupture compared with nonoperative treatment. Specifically, they found a pooled rerupture rate of 3.6% in the operative treatment arm (3.4% best-case scenario and 8.3% worst-case) vs. 12.1% in the nonoperative treatment arm (11.7% best-case and 15.0% worst-case). In contrast, the overall rate of complications, excluding reruptures, was significantly lower for nonoperative treatment (7.1%) vs. operative treatment (18.5%). 

Ankle Arthritis and Reconstruction 

Surgical outcomes were assessed in a retrospective study of patients with critical osseous defects of the hindfoot and/or ankle who had been treated with custom 3D-printed, porous-coated titanium implants³. The investigators found that, of 39 cases, 33% required secondary procedures and 26% required implant removal because of septic or aseptic nonunion. The need for a secondary procedure was strongly associated with neuropathy (odds ratio, 5.76; p = 0.03). 

In a study published in JBJS, researchers reported the long-term survivorship of primary total ankle replacements (TARs) and risk factors for revision in a large cohort (4,748 TARs) with use of data extracted from the French Discharge Records Database⁴. Survivorship of metal components was 84% at 5 years and 78% at 10 years. Independent predictors of all-cause revision were younger age, implants derived from second-generation designs, and an annual institutional volume of ≤10 TARs. 

A recent report presented 20-year follow-up data for an original series of 132 primary cementless TARs performed with use of the Agility prosthesis⁵. Eighty-five percent of the available ankles (107 of 126) were found to still be functioning with the original prosthesis in place at the time of patient death or latest follow-up. A benchmark of 85% survivorship for second- and third-generation arthroplasties was proposed by the study authors. 

“What’s New in Foot and Ankle Surgery” is freely available at JBJS.org. 

What’s New by Subspecialty 

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at JBJS.org. 

Recent OrthoBuzz posts include: “What’s New in Sports Medicine,” “What’s New in Hand and Wrist Surgery,” and “What’s New in Pediatric Orthopaedics.” 

---

References 

1. Li S, Zhu M, Gu W, Hamati M, Hunt KJ, de Cesar Netto C, Simonson TS, Myerson MS. Diagnostic accuracy of the progressive collapsing foot deformity (PCFD) classification. Foot Ankle Int. 2022 Jun;43(6):800-9. 
2. Seow D, Yasui Y, Calder JDF, Kennedy JG, Pearce CJ. Treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis of complication rates with best- and worst-case analyses for rerupture rates. Am J Sports Med. 2021 Nov;49(13):3728-48. 
3. Abar B, Kwon N, Allen NB, Lau T, Johnson LG, Gall K, Adams SB. Outcomes of surgical reconstruction using custom 3D-printed porous titanium implants for critical-sized bone defects of the foot and ankle. Foot Ankle Int. 2022 Jun;43(6):750-61. 
4. Dagneaux L, Nogue E, Mathieu J, Demoulin D, Canovas F, Molinari N. Survivorship of 4,748 contemporary total ankle replacements from the French Discharge Records Database. J Bone Joint Surg Am. 2022 Apr 20;104(8):684-92. 
5. Bedard N, Saltzman CL, Den Hartog T, Carlson S, Callaghan J, Alvine G, Alvine F. The Agility total ankle arthroplasty: a concise follow-up at a minimum of 20 years. Foot Ankle Int. 2021 Oct;42(10):1241-4.