The primary outcome in this retrospective review of the Salto Talaris fixed-bearing TAA system was implant survivorship. Survivorship of the metallic components was 97.5% at a mean of 5.2 years. This survivorship rate is consistent with previously reported data24,29,30 and now demonstrates durability of these implants at a mean of 5.2 years. Although 4 ankles had aseptic loosening and subsidence, only 2 went on to revision TAA. The remaining 2 cases of talar subsidence may have been due, in part, to elevated patient BMI, and we are now more cautious with regard to elevated BMI when considering patients as candidates for TAA. Patients who did not have a discernable cause of trauma to the ankle were assigned the diagnosis of osteoarthritis, which likely led to a higher rate of this diagnosis in our study compared with others29,30.
Postoperative radiographic analysis revealed the presence of lucencies around the metallic components in 31% of our cohort, with the majority of these lucencies found around the tibial component. However, radiographic lucency alone was not an indication for revision surgery. In our cohort, there was no association between the degree of preoperative coronal deformity and development of radiographic lucencies postoperatively. In addition, the patients who developed radiographic lucencies postoperatively did not have a higher risk of revision surgery, nor did they have significantly lower outcome scores.
Our study has several limitations. First, the retrospective nature of the review limits the strength of the conclusions that can be drawn about the Salto Talaris TAA. However, to our knowledge, this study reports the longest follow-up for this implant, and it shows implant survivorship equal to that in previously reported short-term studies.
Although we showed a significant improvement in total range of motion for our cohort, our range-of-motion data were gathered clinically in the office and thus have inherent limitations. We recommend the use of dedicated weight-bearing dorsiflexion and plantar-flexion lateral radiographs to truly evaluate the range of motion through the ankle joint in future studies.
There continues to be no consensus on the appropriate outcome measures to use to assess patients who have undergone TAA. We chose a combination of validated instruments (VAS, SF-36v2, FADI, and SMFA) that have been used in previous studies22,29,37,38 to evaluate our cohort. We lacked preoperative comparison data for our cohort, but we compared our final follow-up data with the final follow-up data of Schweitzer et al.29 and found similar scores for each instrument (VAS, 17.7 compared with 15; SMFA function index, 19.8 compared with 18.6; SMFA bother index, 20.3 compared with 18.3; FADI, 79.1 compared with 84.1).
Although this study expands the current literature on TAA, there are several areas in which future studies can be enhanced. The first is the collection of data both preoperatively and postoperatively using validated outcome instruments. This would allow surgeons to better identify the potential differences between TAA and ankle arthrodesis and communicate them to patients. Second, improvements in radiographic analysis can be made in 2 specific domains. The use of radiographs in range-of-motion calculations would more accurately determine the range of motion coming from the ankle joint and its correlation with gait mechanics. Also, the statistical relationship of radiographic lucencies to implant loosening and outcomes can provide important prognostic information for both the surgeon and patient. Third, evaluation of preoperative and postoperative range of motion could be performed by individuals not involved with the care of the patient using blinding (ankles examined covered in light stockings that conceal surgical scars). Finally, longer follow-up studies are needed to determine the long-term survival of these implants.
Details regarding the 2 patients who underwent revision TAA are available with the online version of this article as a data supplement at jbjs.org.
Investigation performed at the New England Baptist Hospital, Boston, Massachusetts
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