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.