Podcast Summary: Meet the 2025 Leonard Goldner Award Winner

Podcast: The AOFAS Orthopod-Cast
Host: Ben Jackson (AOFAS Podcast Committee)
Guests: Dr. Liz Cody and Dr. Constantine Demetrikopoulos
Episode Date: November 26, 2025

Overview:

This episode features Dr. Liz Cody and Dr. Constantine Demetrikopoulos, recipients of the Leonard Goldner Award, discussing their award-winning study, “Metabolic Activity at the Bone-Implant Interface Following Total Ankle Replacement: A Two-Year Cross-Sectional Study of Asymptomatic Patients Evaluated With 18F-NaF Positron Emission Tomography.” The discussion revolves around what constitutes "normal" metabolic activity at bone-implant interfaces after total ankle replacement, explored with advanced imaging, and how clinicians can better interpret scans in patients without symptoms.

Key Discussion Points & Insights

1. The Study’s Motivation and Research Question

• Defining "Normal":
  There is a current gap in the understanding of what post-operative imaging should look like in asymptomatic (problem-free) patients after total ankle replacement. Most imaging is performed when there is pain, possibly prompting unnecessary revisions.
• Study Objective:
  Determine baseline metabolic activity in the bone surrounding ankle implants using PET scans, to differentiate between normal post-surgical activity and pathology.

  “We wanted to know what metabolic activity around ankle replacements is like in the short period… after surgery. And we wanted to know when that activity...normalizes so we have something to go off of...”
  —Dr. Liz Cody, [00:59]

2. Study Design and Patient Groups

• Patient Cohorts & Imaging Intervals:
  The cohort consisted of eight different asymptomatic patients per time point, imaged at 6, 12, 18, and 24 months after surgery.
• Longitudinal Tracking Limitation:
  Patients were not followed longitudinally through all intervals; rather, each interval had different patients.

3. Why PET over SPECT?

• Technical Differences:
  PET (Positron Emission Tomography) offers improved spatial resolution and dynamic imaging capabilities compared to SPECT (Single Photon Emission Computed Tomography).

  “With PET...you get better spatial resolution...and you can do a dynamic PET scan, so you can actually see the dynamic movement of the tracer...”
  —Dr. Liz Cody, [02:30]

• Current Clinical Practice:
  SPECT is still more commonly used and typically approved by insurance, but PET may become more prevalent as evidence builds.

4. Main Findings and Clinical Implications

• Results Overview:

  • Metabolic activity around the implant remains persistently elevated during the first two years post-op, even in asymptomatic patients.
  • Activity generally increased between 6 and 12 months, then gradually decreased.
  • The talus showed higher uptake than the tibia.

  “We found that activity did remain elevated throughout that two year period...activity increased in the first year...and then it started going down after 12 months...the talus pretty much consistently had higher uptake than the tibia…”
  —Dr. Liz Cody, [04:31]

• Clinical Takeaway:
  Be cautious interpreting bone scan imaging within the first two years after surgery since elevated activity may be normal—even in patients doing well.

  “If you're doing one of these scans within two years of surgery, you just want to really interpret it with a lot of caution.”
  —Dr. Liz Cody, [08:22]

5. Broader Application, Funding, and Future Research

• Funding Challenges:
  Imaging studies can be expensive ($5,000 per scan cited as an example), making large-scale research difficult without institutional or association support.

  “It's really tough to get funding because who's going to pay for this?...I think the AOFAS does a really tremendous job offering funding for these types of research studies.”
  —Dr. Constantine Demetrikopoulos, [07:36]

• Support Opportunities:
  The AOFAS offers several grant mechanisms for funding foot and ankle research.

• Next Steps:

  • Longitudinal patient tracking (same patients over time)
  • Expanding to symptomatic patients and comparing to imaging findings
  • Potential for prospective studies to refine diagnostic criteria for painful ankle replacements

Notable Quotes & Memorable Moments

• On Imaging Confusion:

  “A lot of times you see a lot of activity around the implant. You think, oh, it’s loose. And then people undergo revision surgeries for that. But…the truth is we don’t know what [scans] look like in asymptomatic people.”
  —Dr. Liz Cody, [00:59]

• On Technology Differentiation:

  “SPECT scan is single photon emission computed tomography and PET scan is positron emission tomography...you get better spatial resolution with PET…”
  —Dr. Liz Cody, [02:21 & 02:30]

• On Results and Clinical Application:

  “I think you just want to really interpret it with a lot of caution. And, you know, you're probably going to get more valuable information if you are doing it farther out from surgery, like more than two years out.”
  —Dr. Liz Cody, [08:22]

• On Clinical Frustrations:

  “In my clinical practice...I think the biggest thing I see is gutter impingement...trying to figure that out...”
  —Ben Jackson, [06:25]

• On Practical Guidance for Radiology Reports:

  “So really we should say clinical correlation recommended is that we should say after this.”
  —Ben Jackson, [08:34]

• On Funding Reality:

  “You can do a $50,000 study, a $25,000 study, but even a $10,000 study...the AOFAS does a really tremendous job offering funding for these types of research studies.”
  —Dr. Constantine Demetrikopoulos, [07:36]

Important Segment Timestamps

• [00:59] — Study aim: defining normal metabolic activity in ankle replacements
• [02:21–03:02] — SPECT vs. PET: Why PET was chosen
• [04:31] — Main findings: persistent metabolic activity, differences between tibia and talus
• [05:05 & 05:21] — Limitations and future research directions
• [07:36] — Funding practicalities and AOFAS research opportunities
• [08:22–08:34] — Clinical application: “interpret with caution,” importance of timing in imaging

Final Takeaways

• Elevated metabolic activity on bone scans within two years of total ankle replacement may be normal, even in pain-free patients.
• Clinicians should interpret such imaging cautiously in postoperative patients and consider waiting longer before acting on apparent abnormalities.
• Continued research is needed to refine diagnostic criteria for failed ankle replacements, with future studies ideally including longitudinal tracking and symptomatic cases.
• Funding opportunities exist, particularly through specialty societies like AOFAS.

For more information, visit aofas.org or tune in to future Orthopod-Cast episodes for further research highlights in foot and ankle orthopaedics.