Salto Talaris Total Ankle Replacement

Incidence of revision after primary implantation of the Salto ® mobile version and Salto Talaris ™ total ankle prostheses: a systematic review

The incidence of revision of total ankle replacement prostheses remains unclear. We undertook a systematic review to identify the material relating to the incidence of revision after implantation of the Salto(®) mobile version and Salto Talaris™ total ankle prostheses. Studies were eligible for inclusion only if they had involved primary total ankle replacement with these prostheses and had included the incidence of revision. Eight studies involving 1,209 Salto(®) mobile version prostheses, with a weighted mean follow-up period of 55.2 months, and 5 studies involving 212 Salto Talaris™ total ankle prostheses, with a weighted mean follow-up period of 34.9 months, were included. Forty-eight patients with Salto(®) mobile version prostheses (4%) underwent revision, of whom 24 (70.5%) underwent ankle arthrodesis, 9 (26.5%) metallic component replacement, and 1 (3%) below-the-knee amputation. Five (2.4%) Salto Talaris™ total ankle prostheses underwent revision (3 metallic component replacement and 2 ankle arthrodeses). Restricting the data to the inventor, design team, or disclosed consultants, the incidence of revision was 5.2% for the Salto(®) mobile version and 2.6% for the Salto Talaris™ total ankle prostheses. In contrast, data that excluded these individuals had an incidence of revision of 2.8% for the Salto(®) mobile version and 2.0% for the Salto Talaris™ total ankle prostheses. We could not identify any obvious difference in the etiology responsible for the incidence of revision between these mobile- and fixed-bearing prostheses. The incidence of revision for the Salto(®) mobile version and Salto Talaris™ total ankle prostheses was lower than those reported through systematic review for the Agility™ and Scandinavian Total Ankle Replacement™ systems without obvious selection (inventor) or publication (conflict of interest) bias.

A controlled, comparative study of a fixed-bearing versus mobile-bearing ankle arthroplasty

BACKGROUND

Total ankle arthroplasty is available with fixed-bearing (FB) or mobile-bearing (MB) versions, and there is little consensus on the benefits and drawbacks of each type. This study aimed to compare clinical outcomes of statistically paired series of FB and MB versions of the same ankle prosthesis.

METHODS

The study was a multicenter retrospective comparison between 2 groups: the FB group of 33 consecutive Talaris cases and the MB group of 33 "paired" Salto cases, selected from a database of 313 consecutive cases to statistically match etiology, age, and preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score. All patients were operated upon with the same operative technique and received identical pre- and postoperative clinical and radiographic assessments. The mean follow-up was 24 months for the FB group and 23 months for the MB group.

RESULTS

There was no statistical difference between results of the 2 groups in terms of accuracy of positioning, clinical and radiographic mobility, and morbidity. The most recent postoperative AOFAS scores were higher for the FB group than for the MB group (P = .05). Radiolucent lines were observed in 4 FB patients versus 13 MB patients (P = .02). Subchondral cysts were noted in 1 FB patient and in 8 MB patients (P = .01).

CONCLUSION

There was no notable difference in clinical performance of the FB and MB implants with the numbers available. This short-term study demonstrated that FB ankle arthroplasty had results equivalent to, if not better than, MB ankle arthroplasty. Longer follow-up is necessary to determine the success of this new generation of ankle arthroplasty.

LEVEL OF EVIDENCE

Level III, retrospective case control study.

Salto Talaris fixed-bearing total ankle replacement system

The Salto Talaris total ankle replacement is an anatomically designed fixed bearing prosthesis available in the United States based on the successful design of the mobile-bearing Salto prosthesis available outside the United States. The original mobile-bearing design was modified and the mobile-bearing was transferred to the precision instrumentation at the trial phase evaluation. Instrumentation and technique allow the surgeon to determine the functional joint axis before final implantation. The Salto Talaris total ankle replacement design blends minimal bone resection and optimizes surface area, cortical contact, and ultra-high molecular weight polyethylene conformity. The authors present an overview of the Salto Talaris total ankle replacement surgical technique and pearls for successful application.