Total Ankle Arthroplasty with a Modern Fixed-Bearing System: The Salto Talaris Prosthesis

The Salto Talaris total ankle replacement is a fixed-bearing system that integrates a mobile tibial trial component that allows self-alignment on the distal tibial resected surface, as guided by the talar component. A thorough preoperative assessment is crucial. Meticulous soft-tissue handling is essential. Use intraoperative fluoroscopy and direct inspection to determine the appropriate alignment, tibial component size, and resection level as guided by the external tibial alignment and cutting guides. Use the largest talar component that does not impinge on either malleolus. Careful assessment of ankle range of motion and stability in conjunction with selection of an appropriately sized polyethylene insert and consideration of additional soft-tissue balancing procedures are key to implantation of a well-balanced stable ankle replacement. Completion of a meticulous, layered soft-tissue closure over a drain and placement of a well-padded short leg cast are key to soft-tissue stability and wound-healing. Wound and soft-tissue healing drive the initial postoperative management. Published, prospective studies of the clinical outcomes of modern fixed-bearing total ankle systems are limited in the United States, mainly because FDA approval of these systems is more recent than that of other mobile-bearing options. IndicationsContraindicationsPitfalls & Challenges.