Orthogate Subspecialty Journal Scan: Foot and Ankle
Curated critical appraisals of recent high-impact trials and practice-changing studies across foot and ankle, structured using the SBAR framework for immediate surgical and clinical application.
- 1. Accuracy and Precision of Computer-assisted Navigation Compared With Patient-Specific Instrumentation and Conventional Methods in Total Ankle Arthroplasty. - The Journal of the American Academy of Orthopaedic Surgeons Level I
- 2. The importance of axial rotation of the lower limb - The bone & joint journal Level I
- 3. Sensor-Based Gait Recovery Analysis After Total Hip and Knee Arthroplasty - The Journal of arthroplasty Level I
1. Accuracy and Precision of Computer-assisted Navigation Compared With Patient-Specific Instrumentation and Conventional Methods in Total Ankle Arthroplasty.
Authors: Herbel C, Lopez R, Rueff M, Tupper Z, Hamad C et al. | Journal: The Journal of the American Academy of Orthopaedic Surgeons (Sep 2026) | View Source / DOI
Situation
Investigating clinical outcomes, surgical technique efficacy, and patient recovery profiles in this targeted cohort.
Background
Total ankle arthroplasty (TAA) has become a viable alternative to ankle arthrodesis (AA) in recent years. However, implant longevity is a concern because malalignment of either the tibial or talar implants has been shown to predispose to premature wear and necessary revision surgery. Thus, customized surgical tools such as computer navigation and patient-specific instrumentation have been used to theoretically improve intraoperative alignment of implants. The primary outcome of this study is to compare alignment between a computer-assisted navigation (CAN) system for TAA, a preexisting patient-specific instrumentation (PSI) system, and SRG fluoroscopic techniques.
Assessment & Findings
- Study Design & Methodology: TAA was done on 36 artificial ankle joint specimens by a single surgeon: 12 using CAN, 12 with PSI, and 12 with SRG instrumentation. All specimens were scanned both preoperatively and postoperatively using a high-precision 3D scanning tool. Resections and implant placements were then analyzed in 3D processing software and compared between surgical modalities. Statistical analysis included one-way ANOVA with associated Tukey tests to assess for differences between groups.
- Primary & Secondary Findings: We found that tibial resections were overall most accurate using CAN, with tibial slope measurements demonstrating significant improvements over PSI (P < 0.001) and conventional instrumentation (P < 0.001). PSI was more accurate than SRG when considering the axial cut height of the tibial resection (P < 0.001). In the talar resections, CAN was statistically superior to SRG methods in two of three measured categories (slope: P < 0.001, axial cut height: P < 0.001). However, PSI fared better than CAN in those same categories (slope: P = 0.002, axial cut height: P < 0.001). Employment of the CAN system also decreased implant placement variability (CAN: ± 0.47 mm, ± 0.62 deg; PSI: ± 0.63 mm, ± 1.03 deg; SRG: ± 0.73 mm, ± 1.21 deg).
Recommendation & Practice Takeaway
Clinical Pearl: In this laboratory-based TAA study, we found that both CAN and PSI demonstrated advantages over SRG instrumentation regarding implant placement accuracy. Tibial resections were found to be overall most accurate under CAN guidance, and talar resections were found to be overall most accurate under PSI guidance. In addition, the observed reduction in implant placement variability has potential positive implications for surgeons. However, as this study was conducted on artificial specimens, effects of soft tissue and preoperative deformities or pathologies were not considered. Future studies should include cadaveric specimens with various pathologies to better simulate conditions encountered in an operating room.
2. The importance of axial rotation of the lower limb : a systematic review of measurement methods.
Authors: Favier B, Acker A, Miles J, de Cesar Netto C, Burssens A et al. | Journal: The bone & joint journal (Jul 2026) | View Source / DOI
Situation
Investigating clinical outcomes, surgical technique efficacy, and patient recovery profiles in this targeted cohort.
Background
Contemporary surgical practice requires high-level comparative evidence to guide implant selection, technique optimization, and complication mitigation in foot and ankle.
Assessment & Findings
- Study Design & Methodology: A systematic PRISMA-guided review assessed original CT-based methods, examining inter- and intraobserver reliability (intraclass correlation coefficient (ICC)), frequency of use, and validation.
- Primary & Secondary Findings: Seven FV and nine TT CT-based techniques were identified. FV had a weighted mean of 17.8° anteversion (-9° to 60°). TT had a weighted mean of 30.8° (2° to 82°). ICCs ranged from good to excellent. The Murphy method (FV) and Goutallier method (TT) had the highest reliability and clinical utility.
Recommendation & Practice Takeaway
Clinical Pearl: Lower limb axial rotational profile plays an important role in the management of hip, knee, and ankle arthroplasty surgery as well as many other orthopaedic pathologies. The Murphy and Goutallier methods should be adopted as standard for measuring FV and TT. Their high reproducibility and validation make them ideal for consistent clinical and research use.
3. Sensor-Based Gait Recovery Analysis After Total Hip and Knee Arthroplasty: A One-Year Follow-Up Study Integrating Muscle Strength and Patient-Reported Outcomes.
Authors: Chen W, Wang C, Lee S, Peng S, Chang C et al. | Journal: The Journal of arthroplasty (Aug 2026) | View Source / DOI
Situation
gait analysis, muscle strength assessment, and patient-reported outcome measures. In this prospective cohort study, 84 patients (THA: 36, TKA: 48; age ≥70 years) with Kellgren-Lawrence grade III or IV osteoarthritis were evaluated preoperatively and at 2 weeks and 1, 3, 6, and 12 months postsurgery. Spatiotemporal gait parameters were collected using foot-mounted inertial sensors. Isokinetic dynamometry measured hip abductor (THA) or quadriceps (TKA) strength. The Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement were collected at all timepoints. Correlation and regression analyses identified predictors of recovery. The TKA patients demonstrated significant and persistent gait asymmetry up to three months, which normalized by six months. The THA recovery was more symmetrical, with only transient asymmetry at one month. Preoperative muscle strength was the strongest predictor of 12-month gait speed (β = 0.42, P < 0.001), while radiographic severity (Kellgren-Lawrence grade III versus IV) did not significantly predict functional gait recovery (P = 0.38). By 12 months, both groups approached normative values for gait and strength, with 94.0% of the THA and 92.0% of the TKA patients achieving the patient acceptable symptom state. Muscle strength, rather than radiographic severity, is the critical determinant of functional gait recovery after total joint arthroplasty in the elderly. Preoperative muscle strength assessment should be incorporated into surgical planning to guide personalized rehabilitation. Randomized trials with intervention arms are warranted to establish causality. Level II, prospective cohort study.
Background
Functional recovery after total joint arthroplasty is multifactorial. This study aimed to characterize the 1-year recovery trajectory in elderly patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) by integrating objective gait analysis, muscle strength assessment, and patient-reported outcome measures.
Assessment & Findings
- Study Design & Methodology: In this prospective cohort study, 84 patients (THA: 36, TKA: 48; age ≥70 years) with Kellgren-Lawrence grade III or IV osteoarthritis were evaluated preoperatively and at 2 weeks and 1, 3, 6, and 12 months postsurgery. Spatiotemporal gait parameters were collected using foot-mounted inertial sensors. Isokinetic dynamometry measured hip abductor (THA) or quadriceps (TKA) strength. The Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement were collected at all timepoints. Correlation and regression analyses identified predictors of recovery.
- Primary & Secondary Findings: The TKA patients demonstrated significant and persistent gait asymmetry up to three months, which normalized by six months. The THA recovery was more symmetrical, with only transient asymmetry at one month. Preoperative muscle strength was the strongest predictor of 12-month gait speed (β = 0.42, P < 0.001), while radiographic severity (Kellgren-Lawrence grade III versus IV) did not significantly predict functional gait recovery (P = 0.38). By 12 months, both groups approached normative values for gait and strength, with 94.0% of the THA and 92.0% of the TKA patients achieving the patient acceptable symptom state.
Recommendation & Practice Takeaway
Clinical Pearl: Muscle strength, rather than radiographic severity, is the critical determinant of functional gait recovery after total joint arthroplasty in the elderly. Preoperative muscle strength assessment should be incorporated into surgical planning to guide personalized rehabilitation. Randomized trials with intervention arms are warranted to establish causality.
