Diagnosing and Managing Infection in Total Ankle Replacement

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials

Background:

• Periprosthetic joint infections (PJIs) are a significant complication following total ankle replacement (TAR).
• Management strategies differ significantly between early and late-onset infections.
• Low-grade infections may be underdiagnosed and undertreated, potentially leading to poorer outcomes.

Purpose of the Study:

• To outline effective management protocols for infections occurring after total ankle replacement (TAR).
• To compare the efficacy of different treatment approaches for early versus late-onset TAR infections.
• To highlight the benefits of a two-stage revision protocol for persistent or low-grade infections.

Main Methods:

• Review of treatment outcomes for patients with total ankle replacement (TAR) infections.
• Analysis of early infections managed with debridement, irrigation, and polyethylene inlay exchange.
• Evaluation of two-stage revision protocols involving antibiotic-loaded bone cement spacers for late or low-grade infections.

Main Results:

• Early infections (within 4 weeks) show successful management with debridement, irrigation, and inlay exchange.
• Late infections typically require implant removal.
• Two-stage revision with antibiotic cement spacers demonstrates superior outcomes compared to single-stage revisions for persistent infections.

Conclusions:

• Prompt surgical intervention and appropriate antibiotic therapy are crucial for managing early TAR infections.
• Late-onset and low-grade infections pose a significant challenge, often necessitating implant removal or staged revision.
• A 12-week antibiotic course combined with a two-stage revision, followed by fusion or revision TAR, offers a viable treatment pathway for complex cases.