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Total Ankle Arthroplasty with a Modern Fixed-Bearing System: The Salto Talaris Prosthesis
Karl M. Schweitzer, Jr., MD1; Samuel B. Adams, Jr., MD2; Mark E. Easley, MD2; James K. DeOrio, MD2; James A. Nunley, II, MD2
1 Duke University Medical Center, Box 3000, Durham, NC 27710. E-mail address: karl.schweitzer@duke.edu
2 Department of Orthopaedic Surgery, Duke University Medical Center, Duke Medical Plaza, 4709 Creekstone Drive, Suite 200, Durham, NC 27703
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Based on an original article: J Bone Joint Surg Am. 2013 Jun 5;95(11):1002-11

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Sep 25;3(3):e18 1-12. doi: 10.2106/JBJS.ST.M.00035
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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.


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.

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    Video 1: The critical portions of implanting a Salto Talaris total ankle arthroplasty are demonstrated Dr. James A. Nunley and explained by Dr. Mark E. Easley.

    Running Time: 13:36


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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