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Periprosthetic ankle infection: eradication rate, complications, and limb salvage. A systematic review
Michele Mercurio1, Davide Castioni1, Elvira Porco1
1Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, loc. Germaneto, 88100, Catanzaro, Italy.
Background:
This systematic review investigated the outcomes of revision surgery after periprosthetic ankle infection (PAI).
Methods:
According to the PRISMA statement, 9 studies with 131 PAIs surgically treated and analyzed were included. Demographics and surgical techniques with eradication rates and complications were reported.
Results:
Methicillin-sensitive Staphylococcus aureus (MSSA) (30.4%) and coagulase-negative Staphylococcus (CNS) (26.5%) were the most common microorganisms. The eradication rate was 91.7% with permanent antibiotic spacers (SPC), 84.4% with 2-stage, 79.4% with arthrodesis (AA), and 58.8% with debridement and implant retention (DAIR). DAIR showed a significantly lower eradication rate than 2-stage (p = 0.016) and SPC (p = 0.043). Amputations occurred in 25% of patients after SPC, 8.8% after AA and 3.9% after DAIR. SPC showed a significantly higher amputation rate than DAIR and 2-stage (p = 0.044, and p = 0.017, respectively).
Conclusions:
SPC and 2-stage revision show the highest eradication rates, but 2-stage has a lower risk of amputation.
Insights
Revision surgery for periprosthetic ankle infection (PAI) shows high success with specific techniques. Two-stage revision offers the best balance of infection eradication and lower amputation risk.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Biomaterials in Medicine
Background:
- Periprosthetic ankle infection (PAI) is a serious complication following ankle replacement surgery.
- Effective management strategies for PAI are crucial to improve patient outcomes.
- Revision surgery is often necessary to address persistent or recurrent infections.
Purpose of the Study:
- To systematically review and compare the outcomes of different revision surgical techniques for PAI.
- To evaluate infection eradication rates and complication profiles associated with each surgical approach.
- To identify the most effective strategies for managing PAI.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Inclusion of 9 studies analyzing 131 cases of surgically treated PAIs.
- Data extraction on demographics, surgical techniques, eradication rates, and complications.
Main Results:
- The most common pathogens were Methicillin-sensitive Staphylococcus aureus (MSSA) and coagulase-negative Staphylococcus (CNS).
- Eradication rates: 91.7% for single-stage antibiotic-loaded cement spacers (SPC), 84.4% for 2-stage revision, 79.4% for arthrodesis (AA), and 58.8% for debridement and implant retention (DAIR).
- DAIR had significantly lower eradication rates than 2-stage and SPC. SPC had a significantly higher amputation rate than DAIR and 2-stage.
Conclusions:
- Single-stage antibiotic-loaded cement spacers (SPC) and 2-stage revision demonstrate the highest infection eradication rates for PAI.
- While SPC offers high eradication, 2-stage revision presents a lower risk of amputation.
- These findings guide the selection of optimal revision strategies for periprosthetic ankle infections.
