Understanding barriers to clinical adoption of total ankle replacement in the treatment of ankle osteoarthritis to develop future interventions

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Osteoarthritis of the ankle affects approximately 1-3% of the global population, and is reported in more than 1.5 million patients in the UK. Typically, patients with ankle osteoarthritis are younger than those that develop hip or knee arthritis. Ankle osteoarthritis has a huge impact on quality of life and patient mobility. For osteoarthritis in general, total joint replacement surgery is often used to treat late stage arthritis. However, less than one thousand patients receive an ankle replacement annually in the UK, and ankle replacement is far less successful than hip or knee replacement. There is a huge unmet need for a well functioning device that is simple to implant for this patient group.A purely engineering approach to implant design has been shown to have limitations in other joint replacements. Engagement with all stakeholders to determine the key requirements of a new device will provide an excellent platform for research to optimise existing solutions and approaches, or to develop an entirely new device. The applicant has a medical engineering background and extensive experience in engineering simulation of joint replacement performance and has been developing a research group focused on bioengineering in the ankle. She is aiming to improve the performance of total ankle replacement, to provide a real solution to a wider range of ankle arthritis patients. This discipline hopping grant would embed the applicant within a clinical environment to engage with the stakeholders through the following activities:i) Observation of out-patient clinics and the treatment-decision pathway for ankle arthritis patients (Chapel Allerton Hospital, Leeds)ii) Observation of ankle surgery - total ankle replacement and fusion, to identify the key challenges within the surgical technique at three leading ankle replacement centres within the UK. iii) Hands-on experience of total ankle replacement through a cadaver training courseiv) Undertaking a national survey of ankle surgeons, to extend the information received from a wide range of surgeons, with different levels of experiencev) Patient engagement through a focused interview group (based at Chapel Allerton Hospital, Leeds), and a broader national survey To support these activities, the applicant has proposed a training programme during the grant including Good Clinical Practice, Patient Engagement Training, a Healthcare Economics summer school and will attend seminars with the surgical trainees at Chapel Allerton Hospital.Ultimately, this grant will allow her to increase her knowledge of the surgeon and patient needs for total ankle replacement enabling her to define a robust specification for future ankle replacement design that successfully meets the needs of a wider range of patients. The relationships with surgeons and patients developed through the discipline hop will continue in collaborative research development in the future.