Total Ankle Arthroplasty with a Modern Fixed-Bearing System: The Salto Talaris Prosthesis.
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2014-09
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Abstract
Introduction
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
A thorough preoperative assessment is crucial.Step 2 anterior approach
Meticulous soft-tissue handling is essential.Step 3 tibial preparation
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.Step 4 talar preparation
Use the largest talar component that does not impinge on either malleolus.Step 5 implant trialing
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.Step 6 final implant placement and closure
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.Step 7 postoperative care
Wound and soft-tissue healing drive the initial postoperative management.Results
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
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Schweitzer, Karl M, Samuel B Adams, Mark E Easley, James K DeOrio and James A Nunley (2014). Total Ankle Arthroplasty with a Modern Fixed-Bearing System: The Salto Talaris Prosthesis. JBJS essential surgical techniques, 3(3). p. e18. 10.2106/jbjs.st.m.00035 Retrieved from https://hdl.handle.net/10161/34710.
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Scholars@Duke
Karl Martin Schweitzer
My pursuit of a career in orthopaedics has come as no surprise to those around me. Growing up on our family horse farm in Mechanicsburg, Pa., afforded me many mechanical tasks. Foot and ankle orthopaedic surgery was an obvious choice: the diverse patient population, challenging surgeries, exciting research, and the ability to help my patients get back to the activities they enjoy most.
I do not take for granted my wonderful mentors throughout residency and fellowship training. I am thankful to be practicing back where my interest in foot and ankle was first ignited. My wife Samantha and I are excited to be back living in the Triangle.
As medical missionary, Dr. Albert Schweitzer said, “At times our own light goes out and is rekindled by the spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” It is my responsibility, but also privilege as a surgeon, to empower my patients with ‘that light’, through optimism, knowledge, and ultimately relief, through both non-operative and surgical means.
Mark Erik Easley
James Keith DeOrio
James Albert Nunley
My current research interests are both clinical and basic science. Currently, in the Orthopaedic Research Laboratory, we are investigating the biomechanical properties of the deltoid ligament in the ankle. This is a clinically relevant problem and we will hopefully identify ways to improve the correction of the adult relaxed flat foot. We are also performing a preliminary investigation into the blood supply of the distal tibia to look for a vascularized bone transfer.
We have recently completed a biomechanical study looking at the strength of fixation for proximal metatarsal osteotomies in the correction of hallux valgus and that information has been submitted for publication.
Clinical projects have looked into nerve palsies after total elbow replacement and to reconstructive upper and lower extremity surgery.
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