A collaboration of three leading foot and ankle surgeons and Plainsboro, New Jersey-based Integra LifeSciences Holding Corporation has produced the Cadence Total Ankle System which, in the words of one of the surgeons, “will make total ankle replacement easier, quicker and more reproducible for foot and ankle surgeons.”
Integra Launches New Ankle System

The three world renowned doctors are Tim Daniels of the University of Toronto, David Pedowitz of the Rothman Institute, and Selene Parekh of Duke University.
Parekh described the new ankle system. “This ankle has incorporated many anatomical considerations into its design. It allows the surgeon to maintain more bone stock, and provides options to correctly align the ankle back to its native location. Finally, we’ve streamlined both the Cadence system’s design and instrumentation so it’s more efficient for the surgeon and surgical team, ” he said.
Pedowitz added, “Ankle replacement is a technically challenging procedure. With the Cadence system, we have pared down the complexity of the instrumentation in an intuitive fashion.”
In 2015, Integra LifeSciences acquired the Salto Talaris and Salto Talaris XT ankle replacement products. Company officials believe that the Cadence systems differentiated anatomic design and streamlined surgical technique will complement the proven clinical history and revision features of the Salto Talaris product line. Integra plans to offer a complete set of options to treat the entire continuum of care of ankles—one of the fastest growing extremities segments.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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