Of course I don't know him personally. I have never practiced with/near him.
I know who the guys is... trying to be the new Schuberth or Malay - JFAS editor and PI training (Dr Yu right before he died) and complex recons. It's very good; we need ppl like that. He would be an asset to any school, when he is actually there. I am sure he'll do well with the journal also.
I was saying he takes on a ton of various appointments... flying to many meetings, JFAS editor, a lot of industry consultant $tuff, clinical/surg practice in there somewhere, etc. I doubt he will be at the new pod school daily or teaching student clinic or even teaching a course or two (maybe a "team taught" where he does a few lectures?). Any amount of involvement for him at UTRGV pod is a boon regardless, but it'd be absolutely impossible for him to be core faculty - clinical or lecture - with his current/recent schedule. We had a few DPMs like that when I was in school who were adjunct for lectures and 3rd year office rotations for some students, and it was still good to have their infrequent lectures.
...Doing a ton of TARs is not something I'd brag on, though. It sure doesn't give ppl instant cred. When I was in school, the people who did ring ex fix were the "bigtime" surgeons, lol. A lot of people just want to do the newest stuff, and a lot
get paid huge to try the new. I'm aware it's a minority opinion, but given time, I think TAR will eventually be similar to some guy bragging "I did a ton of silastics" after 1970s and 80s or "I put in hundreds and hundreds of BioPro hemis" after 1990s. And, of course, "I did dozens of Ilizarov and Taylor frames and a hundred ex-fix Lapidus" in the early 2000s. Where arrrrre they now? Those things all still exist, but reimbursements dropped and suddenly, results were pretty haywire, and the indications are now basically paper thin on them.
Check back in 10-20yrs on TARs... they are likely going down that well-traveled surgical road of money eventually drying up and longer and longer term inferior results becoming too obvious to ignore. Most of the ~10yr long term TAR studies are by the inventors or guys paid big to try them... good surgeons - but self-reporting on outcomes they have bias or cash to report well. Ankle is an essential joint, and people will absolutely keep trying. Ankle fusions aren't ideal, but they work very well for a long time. It is no small wonder there is a trail of skeletons of "retired" TAR models. I don't think the TARs will ever be 100% in the garbage heap of opening base wedge, cartiva, Lapidus mini IM nail, etc... but I think the TAR use will peak soon and then dip steadily just like arthroeresis, EPF, PRP, etc did (a decline often tied even more to CPT reimburse getting clipped hard than procedure results... leave it to podiatry to push buttons until they break).
The outcomes on TARs for long term implant survivorship, re-op, amp, etc are *at best* similar to fusions - even with fusions done in much tougher patients (neuropath, obese, bad trauma, varus/valgus, etc), and the AOFAS scores comparisons TAR vs AA are artificial since AA fusion has a significantly lower possible top score. The
only EBM excuse the big TAR docs have (besides their whopper consultant checks) is that "well those were the old models, these new TARs will be even better." Hint: the "new" models are based off old "retired" ones, and new ones have almost no f/u yet... and that old vs new talking point will eventually start to expire, although it can still kick the can down the road for now.
There are already a great many highly skilled F&A surgeons who never did TARs or who have largely or completely abandoned doing them... prominent F&A orthos, ACFAS presidents, etc. Personally, in practice, I'm happy to send any reasonable TAR candidate (align, stability, BMI, bone stock) for a TAR consult with some of the best surgeons I know who do believe in fiddling around with TARs. I would consider sending to Shibuya if he were in my area, but there are a couple guys probably even better within a days drive for any pts I meet who may seek TAR.
I do caution those potential pts of the published TAR re-op rates in what are often not even truly long term studies yet... most patients plan to live much longer than 10-20 more years. I am not sure a long term destiny of TAR, then revision, then STJ fusion, then revision, then complicated graft ankle fusion potentially at elderly age, possible amp is considered awesome. It is hard enough to find a truly good and exp TAR surgeon, and when their good result still needs revision down the line, the pt gets to try to find another highly capable surgeon who does good volume. Joy. It is pretty comparatively easy to find a surgeon to do ankle fusion HWR or an STJ inject once in awhile if that becomes needed. The pts can - and will - make up their own mind (their body, their responsibility), but a good amount of patients will do whatever the doc sells them on. That can be good or very bad.
Can vs should.
🙂
