So Cedric, what would you predict would be the results of a prospective comparative study of PSI-guided supramellular osteotomies versus traditional freehand technique supramellular osteotomies?

So I think it would be absolutely useful to perform this RCT design to compare and investigate the added value of the PSIs, partly also given their cost, which is not insignificant.

However, I think there are quite some challenges if we want to set up this comparative design.

One would be that a surgeon which is used to performing the osteotomies using the PSI guides it's so convenient that it may reduce his freehand skills of performing the same osteotomy, which could introduce a little bias in the study.

The other option we thought of was to perform a study which we compared two different surgeons, one performing only the PSI and the other one doing it only freehand.

But that, of course, also inherently has a bias because it are two different surgeons.

So I think we should definitely do this study to investigate what the added value or added benefit is.

In your experience, approximately how frequently are more proximal realignment procedures performed by your knee colleagues in collaboration with your supramolecular osteotomies? And more importantly, from a practical standpoint, are patients receptive to having additional, more proximal procedures performed when they presented to you only complaining of ankle pain?