Purpose of the study: The purpose of this prospective controlled trial was to evaluate the influence of the tibial stem design on the primary fixation of the tibial base of a total ankle arthroplasty (TAA) and on radiographic remodelling of adjacent bone.

Material and methods: Sixty Salto™ TAA with a short stem were studied with one to three years follow-up. This series was mated with a control series of 60 TAA using conventional ‘cannon’ implants. All patients were assessed clinically with the AOFAS score and radiographically on the loaded ankle.

Results: The two consecutive series were reviewed a mean 23 months. The mean AOFAS score at review was 83.6 points (mean gain 45 points). The functional analysis did not disclose any difference between the two series. There was no evidence of tibial piece migration. The incidence of lucent lines, all partial (32.5%) and bone remodelling was higher in the cannon TAA series than in our short-stem TAA series, but the difference did not reach statistical significance. Considering all prostheses together, the incidence of bone condensation was 39.3%; and bone defects 16%. Young age appeared to be the only factor correlated with the development of defects (p=0.01). One progressive defect was grafted. Two prostheses were removed (one talar necrosis and one malposition).

Discussion: Primary fixation of the tibial base of the Salto™ prosthesis is excellent, irrespective of the design of the anchor stem. Suppression of the cannon did not reduce statistically the phenomena of osteolysis. The mechanism of the periprosthetic osteolysis is probably plurifactorial, associating biochemical and mechanical factors.

Purpose of the study: The results of the first total ankle arthroplasties (TAA) using the Salto™ prosthesis were published in 2004 with mean 35 months follow-up. The purpose of this work was to update the results of the initial multicentric series.

Material and methods: From 1997 to 2000, 98 TAA were performed with a Salto™ prosthesis in three centres: 62 women, 36 men, mean age 56 years, age range 26–81 years, mean BMI 24.3 kg/m². The patients had osteoarthritis (n=65; posttraumatic 43, post-instability 8, primary 14), rheumatoid arthritis (n=29), and sequel of septic arthritis (n=4). At last follow-up, nine patients had died (none had had revision surgery of the ankle) and one patient had been amputated for an unrelated reason. The remaining patients (88 TAA) were reviewed in an outpatient clinic with a mean 102 months follow-up (range 65–134). None of the patients were lost to follow-up.

Results: Seven prostheses were replaced by an arthrodesis (six osteoarthritis and one rheumatoid arthritis): three for defects at 44, 72 and 101 months after implantation, two for unexplained pain after 32 and 57 months, one for tibial loosening after 62 months and one for infection after six months. One tibial piece was changed for loosening and fracture of the polyethylene insert after 100 months (revision with a longer anchor piece). Two 3 mm polyethylene inserts were changed alone for fracture after 72 and 122 months. Five TAA were reoperated for stiffness: removal of bone fragments±synovectomy. Four TAA were grafted for secondary defects (two tibia and two talus). One lateral maleolar piece was removed for loosening after 88 months. There were two infections treated by synovectomy, wash-out and antibiotic therapy. The survival rates were 92% for failure=removal of the prosthesis; 91% for removal or replacement of one component; 89% for removal or replacement of one piece, including the polyethylene insert. The survival rate (prosthesis removal) was better for rheumatoid disease (97%). The AOFAS score at last follow-up was 81.5±12 (80.5±10.3 for osteoarthritis and 76.4±14.8 for rheumatoid disease).

Conclusion: These results underscore: the importance of rigorous technique and careful patient selection (five revisions for defective technique); the higher risk of infection (three cases); the importance of the thickness of the poly-ethylene insert (three fractures on 3mm inserts). Seven patients underwent revision to graft defects, four successfully and three failures (secondary arthrodesis).

Introduction: The goal of this study is to relate our experience about a third generation model of a Total Ankle Arthroplasty (TAA) Salto^® (Tornier™) by evaluating a prospective, homogenous and continuous serie of 130 TAA.

Materials and Methods: From 1997 to 2002, 130 TAA had been implanted to 125 patients, mean age 57 year (19 to 84). This procedure was performed by two experimented surgeons. Indications for arthoplasty were post-traumatic osteoarthritis in 57%, osteoarthritis in chronic laxity in 15%, rheumatoïd arthritis in 12%, primitive osteoarthritis in 10%, and 6% other. Collection of preop, postop and follow up datas was prospective. Radiographs were numerised and treated by a specific software. We considered as a failure when the implant was removed.

Results: After a mean follow up period of 44 months [12 – 108], 10 patients were lost to follow up, without complication, 4 patients died, without relationship to the TAA, but they had sufficient follow up, 9 arthroplasties were converted to arthrodesis, leaving a 92,5% success rate. Postoperative main complications were cutaneous problems (18/130). In one case, a skin necrosis led to a secondary infection that requested implant removal.

Long folllow up showed that main complications were pain and bone cysts, which required arthrodesis in 8 cases. Survivorship analysis at 108 months were 83% [IC5%: 72–95]. At follow up, clinical AOFAS ankle score was significantly raised (31% preoperative to 84% at follow up). A SF36 quality of life score was available for 85 patients. Physical score was 60, mental score 66 and total score was 64.

Discussion: This study has the avantages of being prospective and continuous. Clinical results and failure rate were encouraging. Infection rate less than 1% may be in relation with the low rate of patient with rheumatoïd arthritis. No significant difference of the result could be find according to the initial indication.

Conclusion: These mid-term results are concordant with orther series of third generation TAA. We remain concerned because of bone trabeculation modification and pain without obvious anatomical abnormality: long term follow up is necessary. Mid term results confirm TAA as a therapeutic option for ankle pathology.