Total Ankle Arthroplasty with a Modern Fixed-Bearing System: The Salto Talaris Prosthesis.
Introduction: The Salto Talaris total ankle replacement is a fixed-bearing system that integrates a mobile tibial trial component that allows self-alignment on the distal tibial resected surface, as guided by the talar component. Step 1 Preoperative Planning: A thorough preoperative assessment is crucial. Step 2 Anterior Approach: Meticulous soft-tissue handling is essential. Step 3 Tibial Preparation: Use intraoperative fluoroscopy and direct inspection to determine the appropriate alignment, tibial component size, and resection level as guided by the external tibial alignment and cutting guides. Step 4 Talar Preparation: Use the largest talar component that does not impinge on either malleolus. Step 5 Implant Trialing: Careful assessment of ankle range of motion and stability in conjunction with selection of an appropriately sized polyethylene insert and consideration of additional soft-tissue balancing procedures are key to implantation of a well-balanced stable ankle replacement. Step 6 Final Implant Placement and Closure: Completion of a meticulous, layered soft-tissue closure over a drain and placement of a well-padded short leg cast are key to soft-tissue stability and wound-healing. Step 7 Postoperative Care: Wound and soft-tissue healing drive the initial postoperative management. Results: Published, prospective studies of the clinical outcomes of modern fixed-bearing total ankle systems are limited in the United States, mainly because FDA approval of these systems is more recent than that of other mobile-bearing options. What to Watch For: IndicationsContraindicationsPitfalls & Challenges.
Schweitzer, KM; Adams, SB; Easley, ME; DeOrio, JK; Nunley, JA
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