PhD defence Joris Petrus Sebastiaan Hermus

"The pathway to optimal ankle replacement surgery: The pursuit of solutions" 

The Pathway to Optimal Ankle Replacement Surgery – The Pursuit of Solutions examines how outcomes of total ankle replacement (TAR) can be improved. In our CCI cohort, intraoperative fractures (small breaks during surgery) and impingement (where the prosthesis rubs against the joint edges) were the most common complications, a finding confirmed by our literature review of 16,694 TAR procedures. Complications and failures highlight the importance of the surgical learning curve, requiring at least 30 TAR procedures. Nationwide data from the Dutch Arthroplasty Register identified key risk factors for failure, including younger age, higher body weight, and prior osteochondral defect treatment. Fewer complications were observed in the Infinity cohort, suggesting improved patient stratification. Our computer model demonstrated the biomechanical effects of malalignment, and a validated radiographic tool was developed to improve alignment assessment. Standardised reporting of complications and failures is essential. Together, these findings show that surgical precision, careful patient selection, and consistent documentation are vital for safer, longer-lasting, and patient-centred TAR.

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