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Updated: Aug 5, 2026
Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Diagnostic yield of preoperative tibiotalar aspiration and bone biopsy before surgery for post-traumatic tibiotalar
Grégoire Rougereau1, Agathe Yvinou2, Damien Marmouset3
1Service de chirurgie orthopédique et traumatologique, Clinique Belharra, 2 allée Docteur Robert Lafon, 64100, Bayonne, France; Service de chirurgie orthopédique et traumatologique, Clinique Jean Le Bon, 35 rue Jean Le Bon, 40100, Dax, France.
Background:
Persistent infection should be excluded before tibiotalar arthrodesis or total ankle replacement in patients with post-traumatic ankle osteoarthritis and a history of open fracture or previous infection. However, the diagnostic value of routine preoperative microbiological sampling in clinically quiescent ankles remains uncertain.
Purpose:
To evaluate the diagnostic yield of routine preoperative tibiotalar aspiration and bone biopsy performed before definitive surgery for post-traumatic tibiotalar osteoarthritis in patients considered at potential risk for persistent infection.
Study Design:
Retrospective single-center case series.
Methods:
Twenty-seven patients with isolated post-traumatic tibiotalar osteoarthritis underwent routine preoperative microbiological sampling before tibiotalar arthrodesis or total ankle replacement. Sampling was performed more than one year after the initial septic-risk event. Cultures were considered indicative of infection only when a virulent pathogen was isolated or when the same low-virulence organism was recovered from the majority of specimens.
Results:
Sampling was performed a mean of 6.6 ± 5.7 years after trauma. Seventeen patients had negative or non-diagnostic cultures, and nine had cultures interpreted as contaminants. Only one patient (4%), who presented with clinical signs of inflammation before sampling, had a clinically actionable positive biopsy that was confirmed intraoperatively. No postoperative infectious complications occurred during follow-up.
Conclusions:
Routine preoperative tibiotalar aspiration and bone biopsy demonstrated limited diagnostic value in clinically quiescent post-traumatic ankles sampled more than one year after the initial septic-risk event. Positive cultures more often represented contamination than clinically relevant infection, supporting a selective rather than routine use of preoperative microbiological sampling.
