The Salto Ankle Prosthesis
Meet your new ankle
The Salto ® Total Ankle Prosthesis is the latest generation ankle replacement that mimics the anatomy and flexion/extension movement of the natural ankle joint, and is an alternative to traditional ankle fusion.
I have been working with this advance implant for 10 years and the National Tournier reference centre for this implant. What this means is that I have the job of teaching other orthopaedic surgeons the surgical techniques for implanting and adjusting this prosthesis.
The Salto Total Ankle Prosthesis is a precision fixed-bearing design founded on the Original Salto mobile-bearing ankle prosthesis, which has been in use since 1997 and at 6.4 year average follow-up (5-8.5) has a 93% survival rate for the implant. Which is an impressive performace.
Why is it such a good design?
The quality and precision of the prosthesis itself is only part of the story. Decades of experience in joint replacement have shown that it is the precise positioning and perfect alignment that give the best long term results. The implant should also be sized for each individual patient, to match the contours of their body. Those decades of experience are constantly being fed back into the improvement of the product and techniques.
So the new joint itself comes with an impressive toolkit of tools and jigs that tailor the fitting of the prosthesis with incredible precision.
A little like the old engineering adage, 'Measure twice, cut once', the modern approach to joint replacement is that if you want a precision piece of engineering to work well and have a long life, then the most important thing is to fit it precisely in the first place.
A key principle is that the mobile-bearing concept has become successful not just because we have better implants, but that the techniques and tools to fit them have become so comprehensive.
One size doesn't fit all
The ankle joint does a lot of work and takes the full weight of your body and must be strong and resist movement in all directions. Earlier generations of ankle implant showed that cementing the prosthesis in place just wasn't enough, so the latest implants are designed to be fitted and remain solid without cement being used.
The Salto is an unconstrained and cementless prosthesis offering excellent fixation with shaped extensions that key into matching slots in the bones.
As no two ankles are quite the same, the Salto components come in 4 or 5 different sizes, which can be 'mixed and matched' to refine the fit. These reproduce more accurately the natural movement of the ankle. The combination of component sizes (tibial implant, mobile insert and talar implant) give the surgeon freedom of choice and permit a customized solution for each case.
When people see the amount of kit involved in ankle replacement, their first reaction is that it looks more like advanced engineering than medicine and they are not wrong.
Ankle replacement surgery is amongst the most complex of orthopaedic procedures, which is why it is important that it is carried out by the most highly trained surgeons.
If you are of a technical frame of mind and would like to read chapter and verse of the technology behind the fitting of the ankle prosthesis, here is a pdf you can download.