Swarnakar R. Letter to the Editor: Learning curve considerations in lateral-approach total ankle replacement. World J Orthop 2026; 17(7): 118518 [DOI: 10.5312/wjo.118518]
Corresponding Author of This Article
Raktim Swarnakar, MBBS, MD, Assistant Professor, Faculty of Physical Medicine and Rehabilitation, National Cancer Institute, Jhajjar Campus, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Delhi, India. raktimswarnakar@hotmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
letter
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Swarnakar R. Letter to the Editor: Learning curve considerations in lateral-approach total ankle replacement. World J Orthop 2026; 17(7): 118518 [DOI: 10.5312/wjo.118518]
World J Orthop. Jul 18, 2026; 17(7): 118518 Published online Jul 18, 2026. doi: 10.5312/wjo.118518
Letter to the Editor: Learning curve considerations in lateral-approach total ankle replacement
Raktim Swarnakar
Raktim Swarnakar, Faculty of Physical Medicine and Rehabilitation, National Cancer Institute, Jhajjar Campus, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Author contributions: Swarnakar R contributed to conception and design; Swarnakar R also contributed to literature search and writing; author read and approved the final version of the manuscript to be submitted.
Conflict-of-interest statement: The author declares that there are no conflicts of interest related to this work.
Corresponding author: Raktim Swarnakar, MBBS, MD, Assistant Professor, Faculty of Physical Medicine and Rehabilitation, National Cancer Institute, Jhajjar Campus, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Delhi, India. raktimswarnakar@hotmail.com
Received: January 5, 2026 Revised: January 25, 2026 Accepted: March 9, 2026 Published online: July 18, 2026 Processing time: 187 Days and 18.1 Hours
Abstract
This letter comments on a retrospective cohort study published in World Journal of Orthopedics by Liszka et al, examining the learning curve of lateral-approach total ankle replacement (TAR) using the Zimmer™ system. The study provides a multidimensional evaluation of surgeon performance by integrating patient-reported outcome measures, operative efficiency, and complication profiles. Notably, improvements in pain and function, assessed using the Manchester-Oxford Foot Questionnaire and the European Foot and Ankle Society score, were consistent from the earliest cases, suggesting early stabilization of patient-reported outcomes despite increasing surgical experience. In contrast, operative time and complication rates improved progressively and plateaued after approximately 25-30 cases, reflecting maturation of technical proficiency. This article highlight key methodological strengths, including single-surgeon consistency, validated outcome measures, and structured learning-curve analysis, while also addressing limitations related to retrospective design, attrition, procedural heterogeneity, and generalizability. The concentration of infection-related complications in patients with inflammatory arthritis underscores the importance of careful patient selection and preoperative optimization, particularly during the early learning phase. Overall, the in-press study contributes meaningful insights into the learning dynamics of lateral-approach TAR and informs surgical training, credentialing, and future prospective investigation.
Core Tip: This letter highlight that in lateral-approach total ankle replacement, patient-reported pain and functional outcomes can stabilize early in a surgeon’s experience, while operative efficiency and complication rates continue to improve with increasing case volume. By integrating validated outcome measures with technical and safety metrics, the in-press study demonstrates that the learning curve of this complex procedure is multidimensional rather than linear. Careful patient selection and preoperative optimization-particularly in patients with inflammatory arthritis-remain critical during the early learning phase, and structured training pathways may facilitate safer adoption of the lateral approach.
