The Orthobullets Podcast Podiums | Foot & Ankle | Ankle Arthroplasty
Nov 4, 2025
Dr. Justin Greisberg, a foot and ankle surgeon renowned for his expertise in ankle arthroplasty, joins the discussion to delve into the complexities of this surgical procedure. He highlights the unique anatomical challenges of ankle replacements compared to other joints. The panel explores when to prefer the lateral approach over the anterior, the debate between fusion and replacement, and the introduction of total talus implants for severe cases. They emphasize the importance of skepticism in adopting new technology and techniques in surgery.
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Why Ankles Are Different
- Ankle arthroplasty faces unique challenges like limited soft tissue, small bone surface area, and high implant pressures.
- These factors cause problems such as subsidence and make access and fixation more complex than other joint replacements.
The Transfibular Approach Story
- Surgeons experimented with medial then lateral (transfibular) approaches, cutting the fibula and ligaments to access the joint.
- The lateral approach promised better exposure but required complex jigs and caused logistical headaches in the OR.
Fellowship Experience Then Abandonment
- Bonnie trained extensively with the lateral technique and performed dozens during fellowship but stopped using it in practice.
- She found the logistics, external fixation frame setup, and staff demands made it impractical outside specialized centers.