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

[Introduction][1] 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. [Step 1: Preoperative Planning][2] A thorough preoperative assessment is crucial. [Step 2: Anterior Approach][3] Meticulous soft-tissue handling is essential. [Step 3: Tibial Preparation][4] 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. ![Figure][5] [Step 4: Talar Preparation][6] Use the largest talar component that does not impinge on either malleolus. ![Figure][5] ![Figure][5] ![Figure][5] [Step 5: Implant Trialing][7] 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. ![Figure][5] [Step 6: Final Implant Placement and Closure][8] 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. ![Figure][5] [Step 7: Postoperative Care][9] Wound and soft-tissue healing drive the initial postoperative management. [Results][10] 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. [What to Watch For][11] [Indications][12] [Contraindications][13] [Pitfalls & Challenges][14] [Introduction][1] 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. [Step 1: Preoperative Planning][2] A thorough preoperative assessment is crucial. [Step 2: Anterior Approach][3] Meticulous soft-tissue handling is essential. [Step 3: Tibial Preparation][4] 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. ![Figure][5] [Step 4: Talar Preparation][6] Use the largest talar component that does not impinge on either malleolus. ![Figure][5] ![Figure][5] ![Figure][5] [Step 5: Implant Trialing][7] 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. ![Figure][5] [Step 6: Final Implant Placement and Closure][8] 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. ![Figure][5] [Step 7: Postoperative Care][9] Wound and soft-tissue healing drive the initial postoperative management. [Results][10] 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. [What to Watch For][11] [Indications][12] [Contraindications][13] [Pitfalls & Challenges][14] [1]: #sec-11 [2]: #sec-12 [3]: #sec-13 [4]: #sec-14 [5]: pending:yes [6]: #sec-15 [7]: #sec-16 [8]: #sec-17 [9]: #sec-18 [10]: #sec-19 [11]: #sec-20 [12]: #sec-21 [13]: #sec-22 [14]: #sec-23