Early Outcomes of the 3-Component Salto Total Ankle Arthroplasty and Management of Major Complications

Category: Ankle; Ankle Arthritis Introduction/Purpose: The popularity of total ankle arthroplasty (TAA) increased. Despite the favorable outcomes reported after TAA, there are many complications and subsequent reoperations after surgery. In this study, we evaluate the early clinical and radiologic outcomes of the Salto mobile bearing 3-component total ankle prosthesis, especially in terms of complications and reoperations. Methods: TAA was performed in 120 consecutive ankles (115 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to May 2021 with at least 2-year follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Radiographic outcomes were also evaluated with standing manner. Reoperation is defined as non-revisional secondary surgery involving the ankle not the prosthesis. Results: VAS pain score decreased from 6.7 (range, 2–10) pre-operatively to 1.5 (range, 0–8) at last follow-up (p < 0.05). AOFAS score increased from 36.2 (range 3–85) to 86.0 (range 15–100) at last follow-up (p < 0.05). Overall satisfaction rate was 88%. Even with such good clinical outcomes, complications were also identified. There were 22 cases with osteolysis, and 14 cases among them required additional bone graft or cementation. One ankle with talar component subsidence underwent revision procedure. Three ankles with surgical site infection also needed reoperation procedure, and 1 case among them was converted to tibio-talo-calcaneal arthrodesis at 3 months postoperatively. Post-operative varus tilted ankle were observed in 5 ankles that underwent reoperation procedures such as lateral ligament reconstruction. Conclusion: The TAA using single Salto 3-componenet implant showed favorable early outcomes. Nevertheless, there were many complications that needed reoperation procedures during the 2-year follow-up, so periodic close observation is necessary. In reoperation, proper diagnosis of problems and skilled procedures are required.