SLR - May 2017 - Shyam A. Sheth

Salto Talaris Total Ankle Arthroplasty: Clinical Results at a Mean of 5.2 Years in 78 Patients by a Single Surgeon

Reference:
Hofmann KJ, Shabin ZM, Ferkel E, Jockel J, Solevnkai MP. Salto Talaris Total Ankle Arthroplasty: Clinical Results at a Mean of 5.2 Years in 78 Patients by a Single Surgeon. J Bone Joint Surg Am. 2016 Dec 21; 98 (24): 2036–2046.

Reviewed By: Shyam A. Sheth, DPM
Residency Program: Temple University Hospital, Philadelphia, PA

Podiatric Relevance: A common condition seen by foot and ankle surgeons is severe or end-stage arthritis of the ankle joint. Traditionally, this is treated by a tibio-talar fusion; however, this inhibits many patients' activities of daily living. Recent advancements in total ankle arthroplasty (TAA) have made ankle replacements a viable option for many patients. This study seeks to report the clinical results of a large cohort of patients treated with fixed-bearing TAA by a single surgeon.

Methods: This is a retrospective study evaluating 81 consecutive Salto Talaris TAA prosthesis replacements for end-stage arthritis in 78 patients. Alignment was evaluated using preoperative weightbearing ankle radiographs, and the amount of deformity was evaluated. Severe malalignment was defined as < 20 degrees of valgus and > 30 degrees of varus. All ankle arthroplasties were performed by one surgeon. Those who were excluded from the study were patients who had severe comorbid conditions or high-risk musculoskeletal issues. Postoperatively, patients were admitted for pain control and 24 hours of antibiotics and were strictly nonweightbearing for three weeks. The mean age of patients was 64.3 years old, and the mean clinical follow-up was 5.2 years. Postoperative visits were scheduled at three and six weeks, three and six months, one year and then yearly following the index surgery. Prosthesis alignment was evaluated on each set of follow-up radiographs taken at the six-week visit, with any signs of loosening or subsidence documented. Active range of motion was evaluated clinically and was documented during the preoperative visit and at the one-year follow-up visit. Primary outcome measurement is implant survivorship. Sixty-three patients completed standardized questionnaires, including visual analog scale (VAS) for pain and Foot and Ankle Disability Index.

Results: Survivorship of the ankle arthroplasty components was 97.5 percent with a mean follow-up of 5.2 years. Twenty-one percent required a total of 36 subsequent procedures with the most common cause being gutter impingement. There was no significant change in the tibial coronal alignment. Range of motion revealed a statistically significant increase after one year follow-up. Mean VAS score of 17.7 and a FADI score of 79.1.

Conclusions: The Salto Talaris fixed-bearing TAA system is a viable option for those who have end-stage arthritis and do not have severe comorbidities. There continues to be no consensus on the appropriate outcome measures to assess patients who have undergone TAA. There were a number of limitations given the retrospective nature of this study. Range of motion data was gathered clinically in the office rather than using radiographs. TAA shows improvement, and a future higher-level study is needed to evaluate the long-term outcome. Further study comparing the long-term outcomes using validated outcome instruments comparing ankle arthrodesis to arthroplasty would allow surgeons to identify differences and communicate them to patients. 

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