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


OBJECTIVE
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.


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.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Bonnin
Michel
M
Centre Orthopédique Santy, 24 Av Paul Santy, 69008 Lyon, France. bonnin.michel@gmail.com
Gaudot
Fabrice
F
Laurent
Jean-Raphael
JR
Ellis
Scott
S
Colombier
Jean-Alain
JA
Judet
Thierry
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation*; D001845:Bone Cysts / Q000209:etiology / Q000601:surgery; D020878:Device Removal; D005260:Female; D005602:France; D006801:Humans; D007595:Joint Prosthesis; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D020959:Polyethylene