...Better question - are you able to handle any potential tragic complications associated with this both intra and post op?
I only assisted in a half dozen BKAs in residency, and I don't have privileges for that... so nope.
🙂
...I will say this:
follow-up is the enemy of 'good surgery.'
You will probably see a lot of stuff in training that is not practical or optimal in practice (Charcot recon, TAR, various hero surgery). Many surgeons want to do whatever is new; some have relative med mal shielding in 'academic' environment or think they need to try aggressive stuff since they teach (when that should truly mean teach what works best). Almost anything seems reasonable in recovery room. Patients will usually - and unfortunately - do almost whatever the doc tells them to do. Heck, even Cartiva or opening base wedge or ex-fix Lapidus or other silly stuff looked cool for a year or more sometimes.
Some of docs go looking for candidates for new stuff (TARs right now) and tend to "find" what they're looking for. Podiatrists are known as "early adopters." It's just like how some "limb salvage" docs do inane stuff to get surgery and RVUs even if it's a clearly lost cause. That may or may not be in the pt's best interest. Most companies require 10 ankle fusions to do the TAR course, and the vast majority of DPMs don't do that in a whole career. That should tell you how relatively rare this path is for most DPMs. Chances are that by the time you go to take a TAR course, that model will be retired anyways (due to crap results) and they're on to a newer one.... tells you a lot of what you need to know right there.
... So, instead of what's cool or hyped or profitable, think what you'd want a family member to have, based on EBM. Long term studies. Comparison studies. TARs have a ton of issues. Cost is high. They break down. Outcomes are not as good if you don't do a ton. Revision is a nightmare and deep infection is often BKA or very serious chance of it. If they need revision and have moved, there are not a ton of
skilled high volume TAR revision or TAR-to-fusion-with-block-graft surgeons.
There are many many good F&A surgeons - DPM and ortho - who don't do TAR. Some never did, others tried and quit... same for first MPJ implant nonsense. They do other things well, and they could do TAR if they wanted to. They don't. Instead, they do durable tibiotalar arthrodesis or refer it out to higher volume TAR surgeons if the pt has been sold on and is set on that "motion" option.
Personally, I had decided that arthrodesis was the EBM and pt outcomes and cost effective way to go even before starting residency. I had seen enough TAR disasters just on my clerkships... no joke. The EBM was also increasing sketchy for TAR (similar or worse compared to arthrodesis... despite much easier/healthier TAR pts, studies written mainly by TAR designers and biased TAR promoter surgeons). There is a reason for that. Figure out that reason for yourself (read studies, do some fusions, see some TAR), and then decide if you want to do them and why... and as mentioned, how you will get appreciable volume. I can tell you this... you won't have a ton of end stage ankle OA pts as a podiatrist, some won't be surgical candidates, very few would be TAR candidates... and any TAR candidate is also a fusion candidate (converse is NOT true, lol).
