The Salto total ankle arthroplasty: survivorship and analysis of failures at 7 to 11 years

Michel Bonnin, Fabrice Gaudot, Jean-Raphael Laurent, Scott Ellis, Jean-Alain Colombier, Thierry Judet
Clinical Orthopaedics and related Research 2011, 469 (1): 225-36

BACKGROUND: Despite the appearance of new-generation, mobile-bearing, cementless prostheses, total ankle arthroplasty remains controversial. Among the criteria guiding the choice between arthrodesis and arthroplasty, the long-term survival and postoperative function are of critical importance. The mobile-bearing Salto prosthesis has been used in Europe since 1997, but only 2 to 5 years of followup data have been reported.

QUESTIONS/PURPOSES: We analyzed the longer-term survivorship and causes of failures of the Salto prosthesis in a cohort of previously studied patients. We asked whether this prosthesis provided a functional ankle (AOFAS score) and durable radiographic fixation.

PATIENTS AND METHODS: We retrospectively reviewed 96 prospectively followed patients with 98 prostheses implanted between 1997 and 2000. Of those, 85 patients (87 prostheses) had a minimum followup of 6.8 years (mean, 8.9 years; range, 6.8-11.1 years).

RESULTS: The survival rate was 65% (95% CI, 50-80) with any reoperation of the ankle and 85% (95% CI, 75-95) with revision of a component as the end points. Six prostheses were removed for arthrodesis, and 18 ankles underwent reoperation without arthrodesis. We observed three main causes of reoperations: bone cysts (11 patients), fracture of the polyethylene (five patients), and unexplained pain (three patients). The mean AOFAS score was 79 ± 12 points. Radiographic subsidence was observed in three patients and bone cysts in eight patients.

CONCLUSIONS: Our data suggest a high rate of reoperations but only six revisions with arthrodesis with mid-term followup. We observed few patients with loosening and/or subsidence.

LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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