Septic arthritis of the ankle joint

Septic arthritis of the ankle joint is a rare but serious disease. Very few reports in the literature have mentioned the method of care and treatment results of septic ankle. This study was designed to retrospectively review the treatment results and to analyze the prognostic factors of septic arthritis of the ankle inpatients at our hospital. We also formulated a protocol for the management of septic arthritis of the ankle joint.

All records of those patients with a diagnosis of septic ankle from 1985 to 1997 were retrospectively reviewed. There were 29 patients that met the diagnostic criteria of septic arthritis of the ankle joint (21 male and 8 female patients; 6 children and 23 adults). The average follow-up time was 5.5 years (ranging from 1.5 to 13.7 years). The patients' ages, associated diseases, single or multiple joint(s) involved, timing of treatment, and the final results of these cases were assessed. The infecting organism and drug sensitivity were discussed to determine the proper antibiotics regimen.

Staphylococcus aureus was the most common infecting microorganism in the septic ankles. Combined therapy with oxacillin and gentamicine was effective against 88.1% of the infecting microorganisms. The poor prognostic factors for septic ankle included a positive bacterial culture, involvement of multiple joints simultaneously, a delay in treatment, and an increased number of associated diseases. In addition, a high proportion of patients with septic ankle had gouty arthritis (43.5%).

Early treatment (symptom duration of less than 5 days) significantly affected the final results. The early recognition and prompt treatment of this condition may reduce morbidity and mortality. Based on our results, oxacillin and gentamicine are recommended as the first-line antibiotics for the management of septic ankle.