Keywords: Trabecular Metal Total Ankle, Transfibular Approach, Foot and ankle Infection
Introduction/Purpose: With the rapid increase in utilization of total ankle arthroplasty (TAA), the devastating complication of prosthetic joint infection (PJI) is also on the rise. Management of this complication has yet to be standardized. Current practices for ankle PJI management have largely been based on our understanding of hip and knee PJI management. While debridement, antibiotics, and implant retention (DAIR) and staged revision continue to be mainstays of management, there has been limited literature published regarding their efficacy in successful infection eradication. Even less has been published on PJI specifically in transfibular total ankle arthroplasty.
Methods: A retrospective review was conducted on primary transfibular TAA performed by a single surgeon between October, 2012 and July, 2023. Inclusion criteria included patients with diagnosis of PJI that were initially treated with DAIR and had minimum 2-year follow-up from index surgery. Patient demographics, operative reports, and postoperative clinic notes were reviewed to determine PJI management and resolution of infection.
Results: Of the 454 primary TAA cases identified within our study timeframe, 10 had a diagnosis of PJI. 9 of these were managed with DAIR and included in this study. 7/9 (78%) patients successfully underwent DAIR at an average of 3.6 months from primary TAA procedure (range 1 to 4 months). 2/9 (22%) patients underwent DAIR at an average of 9.4 months from primary TAA but were unable to clear their infection and required subsequent staged revision, one underwent successful staged tibiotalar fusion with circular frame fixation, another required below knee amputation (BKA). All 8 patients (excluding BKA) were clinically free of infection at their most recent follow up (average 3.8 years, range 2-8).
Conclusion: While limited in number, this study evaluates the effectiveness of DAIR in managing PJI. Prior studies have shown variable and even limited success of DAIR, especially in more chronic cases of PJI. The DAIR procedure has been the standard initial management of PJI in this cohort regardless of timing of infection and we report a 78% success rate. It is possible that the transfibular approach may be a protective factor influencing our results but further investigation is needed. Ultimately as the incidence of ankle PJI continues to rise, this study serves to provide evidence that it can be effectively managed.
