Total Ankle Arthroplasty Following Prior Infection About the Ankle

We evaluated whether a history of prior infection about the native ankle joint, bone, or soft tissues was associated with a higher rate of infection following total ankle arthroplasty (TAA) when compared with that of primary TAA in the general population.

This is a retrospective review of our institution's TAA registry to identify all patients who reported a prior history of ankle joint sepsis or osteomyelitis and who were subsequently treated with TAA with at least 1-year follow-up. The primary outcome measure was re-infection rate. Secondary outcome measures were patient-reported outcome scores, implant survival, and complications. Twenty-two TAAs were performed in 22 patients, consisting of 9 men and 13 women, with a mean age of 58.4 years (range = 30-80 years). Patients were followed for a mean of 29.3 months (range = 11.4-83.8 months). The length of complete symptom-free interval between the index infection to time of TAA was 8.8 years (range = 0-44 years). These patients had a mean 2.7 (range = 0-13) procedures involving the ipsilateral ankle joint prior to TAA.

No deep infection was observed in this series. Eleven patients were followed for more than 2 years, with postoperative visual analog scale scores decreasing from 53.1 (range = 12-90) to 20.6 (range = 0-89) of 100. Ten of the 11 ankles also had AOFAS ankle-hindfoot and SF-36 scores. Their AOFAS ankle-hindfoot score increased from 38.9 (range = 10-61) to 70.1 (range = 29-90), and SF-36 score improved from 40.6 (range = 3.3-76.4) to 67.6 (range = 36.4-85.4).

Single-stage TAA can be a viable option to treat arthritic ankle pain for those patients with resolved bone or ankle joint infection, producing improved outcomes in pain and function.