Does Surgeon Type Impact Total Ankle Arthroplasty Survivorship?

A national database analysis presented via a poster at the American Society of Podiatric Surgeons (ASPS) Annual Conference suggests that surgeon type—podiatric versus orthopedic—does not significantly influence long-term survivorship or complication rates following total ankle arthroplasty (TAA). The study, authored by Khushiben Patel, BS; Adam Fleischer, DPM, MPH, FACFAS; Rachel Albright, DPM, MPH, FACFAS; Hector Santiago, DPM, AACFAS; Jonathan Hook, DPM, MHA, FACFAS; Dyane Tower, DPM, MPH, FACFAS; and Lowell Weil, Jr., DPM, MBA, FACFAS, challenges assumptions that surgical outcomes vary by specialty training background.

Study Findings: Comparable Survivorship Across Specialties

Using the PearlDiver database, investigators retrospectively analyzed over 170 million patient records from January 2010 through April 2021 to identify adults who underwent total ankle arthroplasty. The final cohort included 13,514 patients, of whom 748 were treated by podiatric surgeons (DPMs) and 12,766 by orthopedic surgeons (MD/DOs).

Outcomes assessed included TAA survivorship, measured by time-to-revision analysis, and postoperative complications, such as infection, venous thromboembolism (VTE), and wound dehiscence. The mean follow-up period was several years, allowing assessment of revision trends and perioperative outcomes.

Results revealed no statistically significant difference in implant survivorship between surgeon types (p = 0.37). The overall revision rate was 3.5%, aligning with national benchmarks. Rates of postoperative infection, VTE, and wound complications were also comparable across both groups.

While podiatric surgeons had a slightly higher proportion of patients with diabetes and comorbidities, complication rates remained consistent, suggesting that training pathway and specialty background did not influence patient outcomes.

Clinical Implications for Podiatric Surgeons

The findings underscore the growing expertise of podiatric surgeons in performing total ankle arthroplasty and support their role in advanced reconstructive foot and ankle procedures. With increasing numbers of DPMs receiving fellowship training in ankle replacement and complex rearfoot surgery, the study adds evidence that outcomes are equivalent to orthopedic peers when standardized protocols are applied.

Clinically, the results suggest that referral decisions should prioritize surgeon experience and case volume over degree type. For healthcare systems, this parity may encourage broader inclusion of podiatric surgeons in multidisciplinary teams and research initiatives addressing ankle arthroplasty.

However, the authors note that further prospective studies with longer follow-up are needed to assess implant longevity and cost-effectiveness among different training groups. Additionally, they acknowledge limitations related to retrospective data and potential confounders such as patient activity level, implant selection, and perioperative care differences.

Concluding Thoughts

This large-scale national study provides compelling evidence that surgeon type does not significantly affect total ankle arthroplasty survivorship or complication rates in the US. Both podiatric and orthopedic surgeons achieved similar long-term outcomes, reinforcing the collaborative future of ankle replacement surgery.

As the authors concluded, “The inclusion of podiatric surgeons in the expanding field of total ankle arthroplasty will continue to advance patient access, innovation, and quality of care.”