Patient-Reported Outcomes and Satisfaction Results on a Modern Fixed-Bearing Total Ankle Arthroplasty: Updated Mean 6-Year Follow-up

Background: Early results of the fixed-bearing total ankle arthroplasty (TAA) have demonstrated improvement in patient-reported outcome measures (PROMs) for patients with end-stage ankle arthritis. The purpose of this study is to update the previously reported PROMs for the largest cohort of US patients undergoing modern fixed-bearing TAA with the Salto Talaris implant. Methods: A retrospective review was completed of 300 consecutive patients who underwent implantation with 321 modern fixed-bearing TAA by a single surgeon. PROMs were collected prior to surgery, at 3 and 6 months, and yearly thereafter. Collected outcome measures included Veterans RAND 12-Item Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS), and visual analog pain scale (VAS). Presurgical and latest available follow-up (>2 years) PROMs were compared using a mixed effect linear regression with significance level alpha = 0.01 using a Bonferroni-adjusted significance threshold to account for testing across the 5 PROMs. Results: Of the 321 TAAs, an updated 300 procedures (282 patients) had a minimum 2-year follow-up. The average follow-up was 75.3 (range, 24-193.9) months. The mean physical VR-12 score increased significantly from prior to surgery to latest follow-up, while mental VR-12 scores did not ( P < .001 and P = .608, respectively). AOS pain and disability scores and VAS pain scores improved significantly ( P < .001). Clinical significance of PROMs was assessed using previously reported minimal clinically important differences (MCIDs), and the average changes in VR-12 physical composite score, AOS Pain and Disability scores, and VAS scores from preoperation to latest follow-up were all greater than the respective MCID values. Conclusion: At midterm follow-up, fixed-bearing TAA with the Salto Talaris implant was associated with improvement in quality of life, pain, and disability. Level of Evidence: Level IV, case series.