Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis

Abstract

Introduction Osteoarthritis of the ankle is a major burden to affected patients. While tibio-talar arthrodesis has been the gold-standard regarding the treatment of osteoarthritis of the ankle joint for many years, at present total ankle arthroplasty (TAA) provides appealing clinical outcomes and is continually gaining popularity. The aim of this study was to evaluate the intermediate- to long-term clinical outcome including the survival rate of Salto Mobile Bearing TAA (Tonier SA, Saint Ismier, France). Material and methods In this retrospective study intermediate- to long-term outcomes measures [Ankle Range of Motion (ROM), American Orthopaedic Foot and Ankle Score (AOFAS score) and survival rate] of 171 consecutive TAA were analysed and compared before and after surgery. Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. Results At a mean follow-up (FU) period of 7.2 ± 2.7 years (range 2.0 to 14.1 years) there was a significant improvement in ankle ROM (total ROM improved from 25.0° ± 15.0° to 28.7° ± 11.3°, p = 0.015; plantarflexion improved from 18.4° ± 11.7° to 20.6° ± 8.2°, p = 0.044; dorsiflexion improved from 6.6° ± 5.7° to 8.1° ± 4.9°, p = 0.011). AOFAS score increased significantly by 41 ± 15 points after surgery (43.3 ± 11.1 before and 84.3 ± 12.0 after surgery, p < 0.001). Overall survival rate within the FU was 81.3% (95% CI 75.3% to 87.3%) with any secondary surgery, 89.9% (95% CI 84.1% to 93.6%) with revision and 93.6% (95% CI 89.8% to 97.3%) with reoperation as endpoint. Conclusion This study endorses the previously reported appealing intermediate- to long-term outcomes of the Salto Mobile Bearing TAA. There was a significant increase in ROM and AOFAS score as well as decent implant survival at final FU.

Arthrodesis and Defect Bridging of the Upper Ankle Joint with Allograft Bone Chips and Allograft Cortical Bone Screws (Shark Screw®) after Removal of the Salto-Prosthesis in a Multimorbidity Patient: A Case Report

“…Salvage arthrodesis after total ankle arthroplasty has a worse outcome than salvage of a primary fusion [ 2 ]. Even the new generation of ankle prostheses does not present a considerable improvement in survival [ 1 , 3 ]. Many difficulties are reported when arthrodesis of the upper ankle joint is performed [ 8 ].…”

“…Especially in younger patients, this is one of the options due to the range of motion, and therefore, the quality of life is higher after total ankle arthroplasty [ 2 ]. However, the survivorship is lagging behind that of hip and knee replacements (5 years in 87% of the patients [ 1 ] and 81% after 7 years [ 3 ] for Salto-prosthesis), with failure rates for replaced ankles approximately double (19% [ 3 ]) compared with hips and knees [ 1 ]. It is still debated whether ankle replacement or ankle fusion is better [ 2 , 4 ].…”

Size of cartilage defects and the need for repair: a systematic review

“…82 Ankle arthroplasty is a treatment option when substantial OA with multifocal chondral damage has already occurred, but the results of ankle arthroplasty are behind that seen in the knee and hip. 83 An alternative to arthroplasty is ankle arthrodesis, however this is associated with limited range of motion, secondary mid/hindfoot arthritis, and a relatively high risk of postoperative infection and nonunion. Cartilage repair and regeneration techniques seek to prevent arthritis in an attempt to prevent or at least substantially delay the need for arthroplasty/arthrodesis.…”

Intermediate to Long-Term Follow-up of the Salto Talaris Fixed-Bearing Total Ankle Prosthesis

“…The same study found 81.3% survivorship at mean follow-up of 7.2 years. 5 Other studies have analyzed long-term outcomes of Salto Talaris in regards to radiographic findings. Day et al found improved tibiotalar alignment of 4.4°, average medial distal tibial angle improved 2.4°, and the average sagittal tibial angle improved 5.3° with at least a 5-year follow-up.…”