• Michel Bonnin, Fabrice Gaudot, Jean-Raphael Laurent, Scott Ellis, Jean-Alain Colombier, and Thierry Judet.
• Centre Orthopédique Santy, 24 Av Paul Santy, 69008 Lyon, France. bonnin.michel@gmail.com
• Clin. Orthop. Relat. Res. 2011 Jan 1; 469 (1): 225-36.

BackgroundDespite the appearance of new-generation, mobile-bearing, cementless prostheses, total ankle arthroplasty remains controversial. Among the criteria guiding the choice between arthrodesis and arthroplasty, the long-term survival and postoperative function are of critical importance. The mobile-bearing Salto prosthesis has been used in Europe since 1997, but only 2 to 5 years of followup data have been reported.Questions/PurposesWe analyzed the longer-term survivorship and causes of failures of the Salto prosthesis in a cohort of previously studied patients. We asked whether this prosthesis provided a functional ankle (AOFAS score) and durable radiographic fixation.Patients And MethodsWe retrospectively reviewed 96 prospectively followed patients with 98 prostheses implanted between 1997 and 2000. Of those, 85 patients (87 prostheses) had a minimum followup of 6.8 years (mean, 8.9 years; range, 6.8-11.1 years).ResultsThe survival rate was 65% (95% CI, 50-80) with any reoperation of the ankle and 85% (95% CI, 75-95) with revision of a component as the end points. Six prostheses were removed for arthrodesis, and 18 ankles underwent reoperation without arthrodesis. We observed three main causes of reoperations: bone cysts (11 patients), fracture of the polyethylene (five patients), and unexplained pain (three patients). The mean AOFAS score was 79 ± 12 points. Radiographic subsidence was observed in three patients and bone cysts in eight patients.ConclusionsOur data suggest a high rate of reoperations but only six revisions with arthrodesis with mid-term followup. We observed few patients with loosening and/or subsidence.Level Of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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