This article is more than 5 years old. Information may no longer be current.
Higher infection rate found with ankle arthroplasty compared to total hips, knees
Researchers found a link between infection and a history of ankle infection and open fractures.
Click Here to Manage Email Alerts
SAN DIEGO – Total ankle arthroplasties may yield a higher rate of infection than total hip and knee replacements, but the same treatment modalities apply, according to Swiss researchers.
They found a 3.1% infection rate in a study of 386 total ankle arthroplasties (TAA) performed from 1996 to 2004.
“We think that’s not a surprise because the soft tissue around the ankles is … often compromised due to multiple prior surgeries. And there can be a pre-existing infection,” Michaela Maria Schneiderbauer, MD, of Olten, Switzerland, said at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. “The infection rate is not higher than what is reported in the literature for arthrodesis.”
Schneiderbauer and her colleagues evaluated 371 patients with 386 ankles that underwent TAA at a single institution. They performed follow-ups at 6 weeks, 3 months, 6 months and then annually.
Until 2000, surgeons performed TAA using the Scandinavian Total Ankle Replacement (STAR) Ankle Joint prosthesis [Link Orthopaedics], but began using the Hintegra Total Ankle prosthesis [Newdeal SA/Integra] thereafter, Schneiderbauer said.
Surgeons diagnosed infection with tissue cultures during revision and found 12 patients with infection at a mean 9 months after initial TAA (range, 5 days to 4 years).
Researchers found a similar amount of early and late infections (more than 3 months postoperatively) with a ratio of 5:7, she said. Five of the infected patients were treated with the STAR and seven were treated with the Hintegra.
Four of the infected patients had a history of previous ankle infections or open fractures, and Schneiderbauer indicated that these infections might have been present for some time.
|
Images: Schneiderbauer MM |
“We would recommend if there is any suspicion in the history or physical of a patient that there could be [an underlying] low-grade infection, [and] that we do bone biopsies at the time of TAA,” Schneiderbauer said.
Pathogens included four Staphylococcus aureus, three coagulase-negative staphylococci, two patients with anaerobes and three with mixed organisms, Schneiderbauer said.
Surgeons prescribed antibiotics to all infected patients for at least 12 weeks. Initial surgical treatment included: irrigation and debridement with implant retention in six patients, liner exchange in two patients, one tibial component exchange and one two-stage exchange.
Over the course of treatment, two patients who underwent irrigation and debridement needed a salvage treatment with ankle arthrodeses, and three patients needed flap coverage for soft tissue defects. At final follow-up, all patients were clinically free of infection, she said.
“Total ankle arthroplasty infections can be managed successfully, and the treatment algorithms should be the same as with hip and knee arthroplasties that are infected,” Schneiderbauer said.
For more information:
- Hintermann B, Schneiderbauer MM, Trampuz A, Widmer A. Infection rate after primary ankle replacement: A cohort study of 386 consecutive ankle replacements. #74. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18, 2007. San Diego.
- Michaela Maria Schneiderbauer, MD, Kantonsspital Olten, Baslerstrasse 150, 4600 Olten, Switzerland; +41-62-311-4043; mschneiderbauer@bluewin.ch. She has no direct financial interest in the products discussed in this article, nor is she a paid consultant for any companies mentioned. The senior author receives royalties as a member of the inventor team for the Hintegra.