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Updated: Dec 25, 2025

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Learning curve assessment for total ankle replacement using the transfibular approach.

Camilla Maccario1, Eric W Tan2, Claudia Angela Di Silvestri1

  • 1CASCO Piede e Caviglia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons
|March 24, 2020
PubMed
Summary

Surgeons experience a learning curve with transfibular total ankle arthroplasty, impacting surgical time, patient outcomes, and alignment. Mastery is achieved after approximately 15-40 cases, highlighting the need for training.

Keywords:
Ankle arthritisFix-bearingLearning curveTotal ankle replacementTransfibular approach

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Medical Device Innovation

Background:

  • Total ankle arthroplasty (TAA) is a key treatment for end-stage ankle arthritis.
  • The transfibular lateral approach is a novel technique for TAA.
  • A learning curve is anticipated with new surgical systems.

Purpose of the Study:

  • To identify and evaluate the learning curve effects of the transfibular approach in TAA.
  • To assess the impact of surgical experience on outcomes and complications.

Main Methods:

  • Retrospective analysis of 76 patients undergoing TAA via transfibular approach.
  • Minimum 24-month follow-up for all patients.
  • Evaluation of intraoperative, postoperative, radiographic, and complication data.

Main Results:

  • Significant learning curve effects observed in operative time, VAS, AOFAS, SF-12 MCS, and alignment (alpha, gamma angles).
  • Surgical time and patient outcomes stabilized after 13-21 patients.
  • Alignment improved, stabilizing by 18 patients.
  • Complication rates stabilized after 39 patients.

Conclusions:

  • A distinct learning curve exists for the transfibular TAA approach.
  • Surgeons should undergo training programs at high-volume centers to master this technique.
  • Experience significantly influences operative efficiency, patient-reported outcomes, and radiographic results.