Background Management of moderate-to-large (1-2.9 cm 2 ) osteochondral lesions of the talus (OLT) remains challenging due to the transition from reparative to replacement surgical strategies and the absence of high-level comparative evidence guiding treatment selection. Methods An international panel of experts participated in a modified Delphi consensus process during the International Congress on Cartilage Repair of the Ankle (ICCRA) meetings held in 2017 and 2025. Survey rounds and structured discussions were used to generate and refine consensus statements. Consensus strength was categorized as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%), and levels of evidence were graded according to established criteria. Results Consensus statements were developed for autologous osteochondral transplantation (AOT), osteochondral allograft transplantation (OCA), scaffold-based cartilage restoration techniques, and emerging extracellular matrix and juvenile cartilage allograft strategies. Autologous osteochondral transplantation was supported as a primary treatment option for cystic, uncontained, and revision lesions, with emphasis on graft continuity and appropriate depth. Osteochondral allograft transplantation was recommended for larger or uncontained lesions and in cases where autograft is contraindicated, with preference for fresh, size-matched grafts used within 28 days. Scaffold-based techniques were identified as viable alternatives in select primary and revision settings, although not superior to AOT for larger lesions. Extracellular matrix cartilage allograft (ECMA) and particulate juvenile cartilage allograft transplantation (PJCAT) potentially enhance cartilage restoration. Conclusion The ICCRA consensus provides a structured, evidence-informed framework for the surgical management of moderate-to-large OLT. Although multiple treatment strategies demonstrate clinical utility, the current literature remains heterogeneous with limited high-level evidence. Further prospective and comparative studies are warranted to better define optimal indications and long-term outcomes for each approach. Level of Evidence: V, Expert consensus

BackgroundThe management of osteochondral lesions of the talus (OLT) is challenging, with 2 main options being conservative and surgical management. Orthobiologic therapies come to bridge the gap between these 2 options; however, inconsistencies in indication, composition, and heterogeneous evidence limit clinical decision-making. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the role of conservative management and injectable orthobiologic strategies in the treatment of OLT.MethodsSeventy-five multidisciplinary experts from over 25 countries and 1 territory participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1-E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%)ResultsIn total, 29 consensus statements were achieved across the 3 meetings. Strong agreement was reached regarding indications and expected outcomes of conservative management, including the role of immobilization and appropriate timing for surgical intervention. Orthobiologic injections, including platelet-rich plasma, concentrated bone marrow aspirate, and hyaluronic acid, were considered appropriate in select patients with persistent symptoms, although no superiority was demonstrated among formulations, preparation methods, or injection strategies. When used as adjuncts to surgical procedures, orthobiologics may improve radiological outcomes, with limited evidence for improvement in clinical outcomes. Technical considerations, including preferred harvest sites and a lack of standardized preparation protocols, were identified, along with key principles for patient counselingConclusionThese international consensus statements establish a standardized framework for the conservative management and use of injectable orthobiologic therapies in OLT. By clarifying indications, technical considerations, and current limitations, this work aims to improve consistency in clinical practice, guide treatment decision-making, and inform future research.

Background Osteochondral lesions of the tibial plafond (OLTPs) are considerably less common than osteochondral lesions of the talus (OLT), and the terminology, prognostic factors, and treatment strategies for these lesions remain poorly characterized. Methods Experts participated in a structured Delphi-based consensus process during the International Consensus Meeting on Cartilage Repair of the Ankle (ICCRA) meeting held in 2019. Blinded surveys, structured questionnaires, literature review, and in-person discussions were used to develop and refine statements. Consensus strength was defined as consensus (51-74%), strong consensus (75-99%), or unanimous (100%). Results A total of 11 consensus statements were developed addressing terminology, prognostic factors, and management of OLTP, all of which achieved strong consensus. Unanimous agreement was reached on the terminology “osteochondral lesion of the tibial plafond.” Key prognostic factors included lesion characteristics, cystic changes, kissing lesions, and hindfoot alignment. Nonoperative treatment may be considered in asymptomatic or nondisplaced lesions, whereas surgical treatment may be indicated for symptomatic or progressive lesions. Bone marrow stimulation was recommended for small, non-cystic lesions; osteochondral transplantation was supported for larger or cystic lesions. Associated pathology such as kissing lesions and malalignment should be addressed concurrently, and salvage procedures may be considered in advanced cases. Conclusion These international consensus statements establish practical guidance for the assessment and management of OLTP by integrating current evidence with expert opinion. By outlining key prognostic considerations and treatment pathways, these recommendations aim to reduce variability in clinical practice and provide a foundation for future investigation in this challenging pathology. Level of Evidence: V, expert consensus

BACKGROUND:Ankle arthrodesis has historically been the standard treatment for end-stage ankle arthritis but may accelerate subtalar joint (STJ) degeneration. Stemmed total ankle replacement (TAR) preserves ankle motion but raises concern for iatrogenic STJ injury from intramedullary instrumentation. PURPOSE:To evaluate the long-term incidence of subtalar osteoarthritis following stemmed TAR at a minimum 10-year follow-up. STUDY DESIGN:Retrospective cohort study. METHODS:A retrospective review identified 70 patients who underwent primary stemmed TAR between January 2012 and December 2013. Sixteen patients met inclusion criteria of ≥10 years follow-up with complete radiographic data. STJ osteoarthritis was graded preoperatively and at final follow-up using the Kellgren-Lawrence Scale (KLS) on weightbearing radiographs. Statistical analysis included Mann-Whitney U and chi-square testing with significance set at p < 0.05. RESULTS:Mean follow-up was 11.49 ± 0.9 years. Two patients (13%) demonstrated radiographic progression in KLS grade, and no patient required subtalar arthrodesis. Postoperative STJ pain occurred in 6 patients (38%), although 4 demonstrated no radiographic progression. STJ pain was significantly associated with moderate-to-severe implant-related complications requiring reoperation (p = 0.0357) but not with KLS progression (p = 0.0510). Radiographic progression was associated with talar collapse rather than isolated STJ degeneration. CONCLUSIONS:At long-term follow-up, stemmed TAR demonstrated minimal progression of subtalar osteoarthritis and no cases requiring STJ fusion.

BackgroundThe evaluation of osteochondral lesions of the talus (OLT) has long been limited by variability in imaging protocols, lesion measurement techniques, and clinical utility of radiographic classification systems. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the work-up, diagnostic imaging, and radiographic classification systems for OLT.MethodsSeventy-five multidisciplinary experts from over 25 countries and 1 territory participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1-E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%).ResultsIn total, 19 consensus statements were achieved across the 3 meetings. Strong agreement was reached for first-line use of weight-bearing radiographs and complementary use of magnetic resonance imaging (MRI) and computed tomography for lesion characterization. Standardized assessment of lesion size in 3 planes and localization using a 9-zone grid were endorsed. Diagnostic arthroscopy was considered to have limited routine value in the setting of advanced imaging. Post-treatment imaging recommendations clarified indications for radiographs and cross-sectional imaging and emphasized the limited correlation between imaging findings and clinical function. Computed tomography-based classification systems were considered more useful for guiding treatment decisions than plain radiographic or MRI-based systems.ConclusionThese international consensus statements establish a standardized imaging-based framework for the evaluation and classification of OLT, improving consistency in diagnosis, treatment planning, and clinical reporting.

BACKGROUND:Ankle osteoarthritis (OA) can significantly impact mobility and quality of life. Total ankle replacement (TAR) has emerged as an alternative to ankle arthrodesis due to its potential for preserving natural joint kinematics. However, it remains unclear if this maintained motion also limits progression of adjacent joint degeneration. OBJECTIVE:This study aims to evaluate the influence of stemmed implants on the progression of subtalar (STJ) osteoarthritis and delayed secondary STJ fusion. METHODS:A retrospective analysis was performed on 115 patients who underwent primary Stryker Inbone® fixed-bearing, stemmed TAR between December 2018 and February 2024. Patients with pre-existing STJ fusion or less than one year of postoperative follow-up were excluded. The final cohort of 72 patients, with a mean follow-up of 2.43 years, underwent radiographic and clinical evaluation of STJ osteoarthritis. The Kellgren-Lawrence Score (KLS) was utilized to assess changes in STJ arthritis preoperatively and postoperatively. RESULTS:Radiographic progression of STJ arthritis was seen in 6.94 % of patients, with only 1.39 % requiring secondary STJ fusion. Only one patient underwent fusion due to avascular necrosis of the talus, resulting in a case of nonunion. Seven patients reported postoperative STJ pain, despite stable radiographic findings, each of which was managed conservatively without additional surgical intervention. CONCLUSION:These findings support and add to the limited body of literature on the use of stemmed ankle implants in limiting progressive adjacent joint arthritis to the STJ in the short term.

As the indication for Tranexamic Acid (TXA) evolves, this study serves as a comprehensive review of the literature evaluating the impact of TXA in foot and ankle surgery. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to evaluate TXA benefits and safety profile in foot and ankle surgery. Inclusion criteria included TXA use in foot and ankle surgery with at least one of the outcomes: wound complications, infections, postoperative bleeding, and risk of thromboembolic events (VTEs). MEDLINE/PubMed and Cochrane Library were searched for eligible studies from inception through April 1st, 2023, utilizing keywords: tranexamic acid with any combination of calcaneal, foot and ankle, total ankle arthroplasty. Risk of bias was assessed by Cochrane Robvis and ROBIN-1 tools. Cochrane Review Manager synthesized individual study data. Of 36 studies reviewed, 7 met inclusion criteria. There was a total of 691 subjects between the two groups: TXA (n = 338) and non-TXA (n = 353). Though statistically not significant, wound complications and postoperative infections were lower in the TXA group compared to non-TXA (15.4 % versus 26.1 %, p = 0.21) and (4.9 % vs. 9.4 %, p = 0.20), respectively. The TXA group experienced statistically lower blood loss compared to the non-TXA group (149 vs. 156 ml, p = 0.002), and showed a lower hemoglobin drop level (122 vs. 138, p = 0.005). TXA use in foot and ankle surgery demonstrated a trend towards lower overall wound complications, risk of infections, risk of postoperative bleeding, with no increased risk for VTEs.

Orthopedic screws are widely used to achieve bone reduction, compression, and construct stability. However, the relationship between insertion torque, interfragmentary compression, and fixation strength, especially when comparing standard screws with NiTiNOL/sustained dynamic compression (SDC), has not been thoroughly investigated. This study measured insertion torque, interfragmentary compression, and fixation strength for two types of headed orthopedic devices—standard and SDC—using solid foam bone replicates and cadaver validation. The study also assessed the interfragmentary compression produced by these devices in the context of simulated bone resorption.Results showed that compression force increased with insertion torque until thread stripping occurred, resulting in a 91.9 % loss of compression in the standard screw group. In contrast, the SDC device maintained significantly higher compression, even beyond the point of stripping. These findings suggest that SDC devices offer increased safety by continuing to apply interfragmentary compression after stripping. The SDC device's ability to generate internal compression allows it to re-engage threads into undamaged bone, potentially compensating for compression loss due to stripping. Clinically, these results indicate that surgeons might benefit from deliberately undershooting peak insertion torque, regardless of the device type, and may prefer NiTiNOL-based SDC devices for their resilience to stripping and bone resorption, ultimately optimizing patient outcomes in foot and ankle surgery.

BACKGROUND Gastrocnemius recession is a popular procedure utilized to treat chronic conditions related to isolated gastrocnemius contracture (IGC). Recent anatomical research detailing variable gastrocsoleus tendon morphology has raised important questions regarding the safety of some traditional recession procedures. Alternative gastrocnemius recession strategies may produce comparable dorsiflexion improvement results while avoiding the surgical risk related to conjoint tendon anatomical variability. METHODS Ten matched cadaver pairs were randomized to receive either a medial gastrocnemius recession (MGR) procedure or a gastrocnemius intramuscular recession "Baumann" procedure. Postoperative dorsiflexion improvement was measured and then compared between groups. Detailed postoperative surgical dissections were performed to assess structures at risk, conjoint tendon morphology, and anatomical symmetry. RESULTS Medial gastrocnemius recession and Baumann procedures were equally effective at producing significant increases in passive ankle dorsiflexion. No sural nerve injuries were observed. Thirty-five percent of specimens showed direct muscular fusion of at least a portion of the distal gastrocnemius muscular tissue to the adjacent soleus. CONCLUSION The MGR procedure produced comparable dorsiflexion improvement results to the Baumann procedure in our cadaver model. Surgeons must account for certain conjoint tendon anatomical variants when surgically treating IGC as traditional recession methods risk tendo-Achilles overlengthening. LEVELS OF EVIDENCE Level V: Cadaver Study.

Osteochondral lesions of the talus (OLT) represent a wide spectrum of cartilage and subchondral bone defects of the talar dome. The etiology is multifactorial, divided into primary and secondary causes. Primary lesions are related to intrinsic host factors, including chronic disease and genetic predisposition. The exact mechanisms of primary OLT are not completely understood, but the common endpoint is likely a deficient blood supply to the subchondral bone. Secondary OLT are the result of mechanical stress, including malalignment, instability, and trauma. There are 2 common patterns of OLT. Anterolateral lesions are almost exclusively associated with an acute traumatic event, where ankle dorsiflexion and inversion cause the anterolateral portion of the talus to impinge on the fibula. Posteromedial lesions are more often associated with both primary and secondary causes.

Category: Bunion; Midfoot/Forefoot; Other Introduction/Purpose: Potential shortening of the first ray is an important consideration when performing a first tarsometatarsal (TMTJ) fusion. However, no previous study has sought to directly quantify the resultant shortening after TMTJ fusion. The purpose of the present anatomic study was to directly assess and compare shortening of the first ray using two joint preparation techniques (curettage, planal resection) for first TMTJ fusion. Methods: Ten pairs of matched lower extremity cadaver specimens were divided into two groups. Preoperative length assessments were performed at the first TMTJ dorsally and plantarly using a digital caliper. In Group 1, joint preparation for first TMTJ fusion was performed with curettage, whereas specimens in Group 2 underwent planal resection. Post-operative length assessments were repeated. All data was analyzed using two-tailed Students t-tests. Results: Mean shortening of the first ray following curettage was 1.1 (range, 0.3 to 2.0) mm dorsally and 1.6 (range, 0.6 to 3.7) mm plantarly; while mean shortening following planal resection was 4.5 (range, 2.7 to 7.9) mm dorsally and 4.6 (range, 2.4 to 8.9) mm plantarly. The measured differences were statistically significant (p <0.001, p=0.001). Conclusion: Both curettage and planal resection resulted in shortening of the first ray after first TMTJ fusion. Planal resection resulted in significantly more shortening, which was also more variable. Surgeons performing first TMTJ fusions may consider curettage over planal resection to mitigate the risk of painful postoperative transfer metatarsalgia.

Symptomatic ankle arthritis is a progressively disabling disease that can adversely affect both mobility and overall general health. As opposed to the hip or the knee, primary idiopathic arthritis of the ankle is relatively rare. The majority of patients with ankle arthritis report a history of ankle trauma. Inciting events range from isolated or recurrent ankle sprains to more traumatic fractures of the talus, malleoli, or tibial plafond. Post-traumatic arthritis is estimated to account for 79.5% of the total cases of ankle arthritis, compared to 1.6% and 9.8% for the hip and knee, respectively. 1 The traumatic etiology leads to an overall younger patient population with arthritis and represents a significant financial burden. Lost productivity and direct medical costs of treatment for lower extremity post-traumatic arthritis account for approximately 11.8 billion dollars annually in the United States. 1

Vertical fixation through stemmed components has been a successful strategy in total ankle arthroplasty. Research in hip replacement surgery has demonstrated increased rates of stress shielding, aseptic loosening, thigh pain, and cystic formation around stemmed femoral implants extensively coated with porous surfaces. While some ankle prostheses have integrated porous coating technology with stemmed tibial implants, there is little to no research investigating the potential negative effects of bone bonding to the tibial stems and possible impact on tibial cyst formation. We performed a retrospective cohort study comparing the incidence of periprosthetic tibial cyst formation in smooth versus fully porous-coated stemmed tibial implants after undergoing total ankle implant arthroplasty. Radiographs were compared for postoperative rates of tibial cyst formation and bone bonding to the tibial stems. Relative risk for reoperation between the smooth and porous-coated implants was investigated. The smooth-stem group showed no incidence of tibial cyst formation nor signs of significant bone bonding to the tibial stems; however, the follow-up matched porous-coated group showed a rate of 63% of cystic formation with associated evidence of bone bonding on final radiographic follow-up (p < .01). Relative risk for reoperation was 0.74. Despite a higher incidence of tibial cyst formation in the stemmed ankle arthroplasty groups with porous coating, reoperation rates were similar. We theorize that the proximal bonding to the porous stem surface could impact the distal stems and result in the observed increase in cyst formation.

Hindfoot osteoarthritis (OA) or deformity involving the ankle and subtalar joint is a disabling condition. Tibiotalocalcaneal (TTC) fusion is an effective salvage option in pathologies where total ankle replacement is contraindicated. The purpose of this study is to compare the union rate of the ankle joint in proximal static versus dynamically locked retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis. An institutional review board-approved comprehensive chart and radiographic review was performed. TTC arthrodesis performed in patients with OA, post-traumatic arthritis, or deformity corrected by retrograde nail were included. Patients with Charcot arthropathy, failed joint replacement, neuropathy, or avascular necrosis were excluded. The primary outcome was ankle joint union with secondary measure of mean time to fusion. A total of 60 patients met inclusion criteria with 30 in the static group (SG) and 30 in the dynamic group (DG). The average age of the static group (SG) and dynamic group (DG) was 56.9 and 54.1 years, respectively. Mean body mass index was 34.03 kg/m2 for SG and 33.43 kg/m2 for DG. The union rate of the ankle joint was slightly higher in the DG but not statistically significant [SG 83.3%, DG 86.6%, p > .05 (p = .83)]. Time to fusion (TTF) in SG was 111.6 days compared to 97.2 days in DG. Dynamically locked intramedullary nails allow continued compression across the arthrodesis site as fusions remodel. Time to union and union rate of the ankle joint was superior in the dynamic group but this was not statistically significant. In this cohort, union rates were excellent in both groups, and no statistically significant difference was seen in the number of nonunions.

BACKGROUND:The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "terminology for osteochondral lesions of the ankle" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS:Forty-three international experts in cartilage repair of the ankle representing 20 countries were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed, and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus, 51%-74%; strong consensus, 75%-99%; unanimous, 100%. RESULTS:A total of 11 statements on terminology and classification reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Definitions are provided for osseous, chondral and osteochondral lesions, as well as bone marrow stimulation and injury chronicity, among others. An osteochondral lesion of the talus can be abbreviated as OLT. CONCLUSIONS:This international consensus derived from leaders in the field will assist clinicians with the appropriate terminology for osteochondral lesions of the ankle.

Category: Ankle; Hindfoot; Other Introduction/Purpose: Short and medium term outcomes of the INBONE I and INBONE II tibial stems have been favorable. The INBONE-2 talus has been shown to have lower reoperation and failure rates compared to its predecessor, INBONE-1 at short term follow-up. The purpose of the present study was to assess mid-term outcomes for the INBONE-2 prosthesis at 5 to 9 years follow-up considering both the tibial and talar components. Methods: All patients who underwent primary total ankle arthroplasty (TAA) with INBONE-2 between July 2010 and July 2014 at a single institution and who were at least 5 years postoperative were included. A total of 15 ankles with a mean follow up 85 (range, 61-113) months met the criteria. Radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 weeks postoperative, and at the most recent follow-up. Medical records were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook at el., respectively. Results: Survivorship for the INBONE-2 at a mean of 85 months was 93.7%. Coronal and sagittal tibiotalar alignment improved after surgery (p=0.081, p=0.15), and was maintained at the most recent follow-up (p=0.684, p=0.837). One ankle (6.7%) required early component revision; while 4 (26.7%) required a non-implant related revision. Six complications (2 high grade, 1 intermediate, and 3 low) in 5 ankles (33.3%) were recorded according to the Glazebrook classification system. Conclusion: The present study is the first to report midterm follow-up after TAA with the INBONE-2. High survivorship, maintenance of correction, and a low incidence of major complications was observed. The most common complication overall was lateral gutter impingement, which accounted for the majority of the non-revisional reoperations.

Category: Arthroscopy; Hindfoot Introduction/Purpose: The purpose of the present study was to assess the radiographic incidence, location, and classification of heterotopic ossification (HO) in patients who underwent total ankle arthroplasty (TAA) with a 4th generation prostheses at a minimum of 1-year follow up. Baseline demographic, radiographic, and operative factors between patents with and without HO were compared. Methods: Ninety ankles that underwent TAA with a 4th generation protheses, INFINITY (n = 62) or CADENCE (n = 28) were followed for an average of 23.7 (range, 12-49) months. Incidence and location of HO was assessed on weight bearing radiographs, and severity graded according to the modified Brooker classification. Data was compared between patents with and without HO to identity any predisposing factors. Results: In 90 ankles that underwent 4th generation TAA, HO incidence was 55.6% (n = 50); 56.5% (n = 35) for INFINITY, and 53.6% (n = 15) for CADENCE. Twenty-five cases of HO were observed posteriorly, 16 anteriorly, and 9 combined. Severity was as follows; class I in 19 cases (38%), class II in 20 (40%), class III in 9 (18%) and class IV in 2 (4%). A single ankle required a non- revisional reoperation for HO debridement; reoperation rate of 2%. Conclusion: The present study suggests a similarly high incidence of HO after TAA with two different 4th generation prostheses (INFINITY 56.5%, CADENCE 53.6%). A trend for differences in location and severity between the prostheses may also be present. Given the paucity of literature, additional studies with longer follow-up are warranted to discern the significance of HO following TAA with 4th generation prostheses.

Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: Current available total ankle replacement constructs offer either proximal projecting pegs (non- stemmed) in various shapes or large stem (stemmed) designs to the superior aspect of the tibia component. Each design offers inherent stability and unique function. Periprosthetic radiolucency can develop post-operatively and lead to adverse effects. However, the incidence and clinical significance of lucency formation amongst stemmed and non-stemmed constructs is poorly understood. Methods: A retrospective radiographic and chart analysis was performed of 256 patients, under a single orthopedic practice, who underwent primary TAA between 2013-2019 with one of 3 total ankle systems. Pre-operative ankle characteristics, intraoperative procedures, as well as post-operative angles, lucency formation, region of lucency formation, and patient outcomes were analyzed. Results: Patients' mean age 65.5 yrs., male n=126 and female n=127, a mean follow-up of 24.3 months for our patient cohort. A total of 149 stemmed and 107 non-stemmed constructs were analyzed. Incidence of periprosthetic tibial lucency formation 33.2%, stemmed implants 10.0%, and 65.4% for non-stemmed implant (p value 0.00001). Conclusion: This paper describes the incidence of periprosthetic formation amongst a stemmed and non-stemmed total ankle arthroplasty cohort. Statistical significance was found when analyzing stemmed vs. non-stemmed incidence of radiolucency formation, this did not correlate with increased incidence of post-operative complications.

Elderly ankle fractures in the elderly represent a substantial healthcare burden. Dual-energy x-ray absorptiometry (DXA) is the gold standard for diagnosis of osteoporosis. However, there is emerging research regarding secondary imaging techniques to evaluate bone mineral density (BMD). The purpose of this systematic review was to summarize the role of secondary imaging techniques for measuring BMD in elderly ankle fractures. A literature search was undertaken using relevant search terms. Articles were screened for suitability and data extracted where studies met inclusion criteria and were of sufficient quality. Eight studies were included in the systematic review. Computed tomography (CT) may have a role in preoperative surgical planning, provide an explanation for injury patterns in elderly patients, and may be correlated with clinical outcomes. High-resolution peripheral quantitative CT may be better suited than DXA for the assessment of ankle fractures due to the resolution of the image and its ability to distinguish between bone compartments, as well as provide a more accurate estimation of bone quality. Quantitative ultrasound has shown promise as a tool for measuring BMD in patients with osteoporosis, but is not able to detect osteoporosis in patients with ankle fractures. This paper helps define the role of each modality in the spectrum of care in the evaluation of osteoporosis as it pertains to elderly ankle fractures.