1121 Salto Talaris Total Ankle Arthroplasties by a Single Surgeon: Midterm Survivorship,Complications,and Patient-Reported Outcomes

Abstract

Background:

Total ankle arthroplasty (TAA) is increasingly used as a motion-preserving alternative to ankle arthrodesis for end-stage ankle disease. The Salto Talaris fixed-bearing prosthesis was designed to enhance joint kinematics while minimizing bone resection and reducing complications seen in earlier implant generations. This study reports midterm clinical outcomes, including survivorship, complications, reoperation and failure rates in a large, single-surgeon cohort.

Methods:

A retrospective review was conducted of 1121 primary TAAs performed in 1023 patients (98 bilateral) between May 2008 and December 2022. Patients with a minimum of 2-year clinical follow-up were included and any patients who failed or passed away before then were accounted for. Data included demographics, comorbidities, preoperative ankle diagnosis, ancillary procedures, intra- and postoperative complications, and patient-reported outcomes measures (PROMs). Complications were identified and then classified by the Glazebrook system (low-, medium-, high-grade). Reoperations and revisions were coded according to the Canadian Orthopaedic Foot and Ankle Society reoperations coding system.

Results:

The mean age at the index TAA surgery was 65.5 (range, 28.7-94.4) years, with osteoarthritis being the most common diagnosis. The average follow-up was 5.5 (range, 2-17.2) years. Key PROMs showed statistically significant improvements from preoperative to latest follow‑up (Veterans RAND 12-Item Health Survey physical component summary, +10.1 [95% CI 8.83-10.77]; Ankle Osteoarthritis Scale [AOS] pain, −29.2 [95% CI 25.43-29.72]; AOS disability, −32.8 [95% CI 29.32-33.80]; visual analog scale for pain, −36.8 [95% CI 32.6-40.7]; all P < .001). Implant survivorship was 94.6% at the time of this report. A total of 240 ankles (21.4%) experienced at least 1 complication. Secondary reoperations occurred in 134 ankles (12.0%), with 61 ankles failing (5.4%) and leading to a revision TAA, conversion to arthrodesis, or an explant to antibiotic spacer. Most failures were due to high-grade complications including aseptic loosening (22/61) and deep infection (19/61). Among the failed ankles, 2 patients ultimately underwent a below-the-knee amputation.

Conclusion:

In this large cohort, the Salto Talaris TAA was associated with improvements in patient-reported quality of life, activity, and pain, and showed high survivorship with relatively low failure (5.4%) and reoperation (12.0%) rates at an average of 5.5 years after index surgery.

Graphical Abstract

This is a visual representation of the abstract.