Periprosthetic joint infection in total ankle replacement: which are the current diagnostic criteria? Infection in Ankle Replacement

Antonio Izzo; Donato Di Gennaro; Arianna Sgadari; Antonio Coviello; Domenico Marasco; Giovanni Balato; Massimo Mariconda; Alessio Bernasconi

doi:10.23750/abm.v94i4.14082

Periprosthetic joint infection in total ankle replacement: which are the current diagnostic criteria?

Infection in Ankle Replacement

Authors

Antonio Izzo University Federico II of Naples
Donato Di Gennaro University Federico II of Naples https://orcid.org/0000-0001-7836-4267
Arianna Sgadari University Federico II of Naples https://orcid.org/0000-0003-2994-3523
Antonio Coviello University Federico II of Naples https://orcid.org/0000-0002-2298-566X
Domenico Marasco University Federico II of Naples https://orcid.org/0000-0001-6065-6990
Giovanni Balato University Federico II of Naples https://orcid.org/0000-0002-0392-4511
Massimo Mariconda University Federico II of Naples https://orcid.org/0000-0002-9906-5124
Alessio Bernasconi University Federico II of Naples https://orcid.org/0000-0002-9427-3178

DOI: https://doi.org/10.23750/abm.v94i4.14082

Keywords:

ankle, replacement, prosthesis, infection, periprosthetic, joint

Abstract

Background and aim: Periprosthetic joint infection (PJI) is among the most common complications of Total Ankle Replacement (TAR) and its management may be challenging. We set out to define which are the criteria currently used to diagnose PJI after TAR. Methods: This PRISMA-compliant systematic review was registered in the Open Science Framework. Multiple databases were searched including clinical studies in which PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design and the diagnostic criteria for PJI. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). Results: Six papers (122 infected TARs) published between 2012 and 2022 were included in this review. Ankle pain with swelling and unexplained increased local temperature were the most common clinical findings leading to a suspicion of PJI. In 100% of cases the diagnosis was confirmed through synovial fluid analysis associated with positive blood tests. In all the revision surgeries intraoperative cultures (at least 3) were performed. In 109 ankles (90%) there was a microbiological isolation. Out of these, 38 (35%) were single organism infections by Staphylococcus coagulase negative and 37 (34%) were single organism infections by Staphylococcus Aureus. The mean mCMS was 37.6 out of 100. Conclusions: There is a lack of diagnostic criteria specific for PJI after TAR. Clinical and laboratory tests inspired to the knowledge in total knee and total hip arthroplasty are generally adopted in the field of ankle arthroplasty. The quality of evidence for studies included in this review was poor.

References

Mehdi Nazim, Bernasconi Alessio, Laborde Julien, Lintz François, Comparison of 25 ankle arthrodeses and 25 replacements at 67 months’ follow-up, Orthopaedics & Traumatology: Surgery & Research, 2019,105(1):139–44. Doi: 10.1016/j.otsr.2018.10.014.

Lintz François, Mast Jef, Bernasconi Alessio, et al. 3D Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement, Foot Ankle Int, 2020,41(1):1–9. Doi: 10.1177/1071100719891411.

Veljkovic Andrea N, Daniels Timothy R, Glazebrook Mark A, et al. Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis, J Bone Joint Surg Am, 2019,101(17):1523–9. Doi: 10.2106/JBJS.18.01012.

Queen Robin M, Adams Samuel B, Viens Nicholas A, et al. Differences in outcomes following total ankle replacement in patients with neutral alignment compared with tibiotalar joint malalignment, Journal of Bone and Joint Surgery - Series A, 2013,95(21):1927–34. Doi: 10.2106/JBJS.L.00404.

Zhou H, Yakavonis M, Shaw JJ, Patel A, Li X In-Patient Trends and Complications After Total Ankle Arthroplasty in the United States, Orthopedics, 2016,39(1) Doi: 10.3928/01477447-20151228-05.

Alrashidi Yousef, Galhoum Ahmed E, Wiewiorski Martin, et al. How To Diagnose and Treat Infection in Total Ankle Arthroplasty. Foot Ankle Clin 2017,22(2):405–23. Doi: 10.1016/j.fcl.2017.01.009.

Culliford D, Maskell J, Judge A, Cooper C, Prieto-Alhambra D, Arden N K Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink, Osteoarthritis Cartilage, 2015,23(4):594–600. Doi: 10.1016/J.JOCA.2014.12.022.

Karzon Anthony L, Kadakia Rishin J, Coleman Michelle M, Bariteau Jason T, Labib Sameh A, The Rise of Total Ankle Arthroplasty Use: A Database Analysis Describing Case Volumes and Incidence Trends in the United States Between 2009 and 2019, Foot Ankle Int, 2022,43(11):1501–10. Doi: 10.1177/10711007221119148.

Bernasconi Alessio, Sadile Francesco, Smeraglia Francesco, Mehdi Nazim, Laborde Julien, Lintz François, Tendoscopy of Achilles, peroneal and tibialis posterior tendons: An evidence-based update, Foot and Ankle Surgery, 2018, 24(5):374–82. Doi: 10.1016/j.fas.2017.06.004.

Izzo Antonio, Vallefuoco Salvatore, Basso Morena Anna, et al. Role of lateral soft tissue release in percutaneous hallux valgus surgery: a systematic review and meta-analysis of the literature, Arch Orthop Trauma Surg, 2022, Doi: 10.1007/S00402-022-04693-X.

Coppola Martina, Sgadari Arianna, Marasco Domenico, et al. Treatment Approaches for Plantar Fasciopathy in Elite Athletes: A Scoping Review of the Literature. Orthop J Sports Med 2022,10(11):232596712211364. Doi: 10.1177/23259671221136496.

Ferrao Paulo, Myerson Mark S, Schuberth John M, McCourt Michael J, Cement spacer as definitive management for postoperative ankle infection, Foot Ankle Int, 2012,33(3):173–8. Doi: 10.3113/FAI.2012.0173.

Myerson Mark S, Shariff Raheel, Zonno Alan J, The management of infection following total ankle replacement: demographics and treatment, Foot Ankle Int,2014,35(9):855–62. Doi: 10.1177/1071100714543643.

Kessler B, Knupp M, Graber P, et al. The treatment and outcome of peri-prosthetic infection of the ankle: a single cohort-centre experience of 34 cases, Bone Joint J, 2014,96-B(6):772–7. Doi: 10.1302/0301-620X.96B6.33298.

Patton Daniel, Kiewiet Nathan, Brage Michael, Infected total ankle arthroplasty: risk factors and treatment options, Foot Ankle Int, 2015,36(6):626–34. Doi: 10.1177/1071100714568869.

Lachman James R, Ramos Jania A, DeOrio James K, Easley Mark E, Nunley James A, Adams Samuel B, Outcomes of Acute Hematogenous Periprosthetic Joint Infection in Total Ankle Arthroplasty Treated With Irrigation, Debridement, and Polyethylene Exchange, Foot Ankle Int,2018,39(11):1266–71. Doi: 10.1177/1071100718786164.

Pfahl Kathrin, Röser Anke, Gottschalk Oliver, et al. Common bacteria and treatment options for the acute and chronic infection of the total ankle arthroplasty. Foot Ankle Surg, 2022,28(7):1008–13. Doi: 10.1016/J.FAS.2022.02.010.

Parvizi J, Gehrke T, Chen A F. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J, 2013;95-B(11):1450–2. Doi: 10.1302/0301-620X.95B11.33135.

Parvizi Javad, Tan Timothy L, Goswami Karan, et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria, J Arthroplasty, 2018,33(5):1309-1314.e2. Doi: 10.1016/J.ARTH.2018.02.078.

Zaidi R, Cro S, Gurusamy K, et al. The outcome of total ankle replacement: A systematic review and meta-analysis. Bone Joint J 2013;95-B(11):1500–7. Doi: 10.1302/0301-620X.95B11.31633.