Total Ankle Replacement Infections
However, the choice between AA and TAR isn’t straightforward, and each has its risks and benefits. Some studies suggest that TAR may have more complications compared to AA.
One significant complication of TAR is periprosthetic joint infection (PJI), which often requires further surgical intervention, such as implant replacement, ankle fusion, or even amputation.
The risk of developing PJI after TAR varies widely, ranging from less than 1% to over 20%. Treating ankle infections is particularly challenging due to the ankle’s delicate soft tissues, making infections harder to manage. The primary goals in treating PJI are to eliminate the infection and restore pain-free function to the leg. Surgical options for TAR-related PJI include cleaning the infection and retaining the implant (DAIR), replacing the implant in one or two stages, or resorting to amputation. Following TAR replacement, additional surgeries, such as a repeat TAR or ankle fusion, may be necessary.
Unfortunately, there’s limited information available on ankle implant infections compared to hip or knee replacements. Because ankle infections are rare, there are only a few small studies, and they often lack comprehensive information about causes, bacterial types involved, treatment approaches, and post-treatment outcomes.
Total ankle replacement is becoming increasingly common for treating ankle osteoarthritis (OA), but along with its rising popularity comes an increase in complications.
For this study around 3.8% of ankle implants were found to have periprosthetic joint infections (PJIs), a rate similar to what other studies have reported. Among studies with at least 50 implants, infection rates after ankle replacement ranged from 2% to 8.5%.
PJIs occurring after ankle replacement surgery are less frequent in the early stages compared to later stages. Our review identified 53 early PJIs compared to 156 chronic cases.
Various treatments are available for infected ankle replacements, including cleaning the infection (DAIR), replacing the plastic components, or removing the entire implant.
Cleaning the infection through irrigation and debridement is often performed shortly after surgery, especially if only the plastic component needs replacement. However, there’s limited data on its effectiveness for ankle replacements compared to other joints. Some studies have indicated that cleaning the infection alone may not be very successful, with all cases treated this way experiencing reinfection. Other treatments, such as replacing the entire implant, might offer better results, but further research is necessary to confirm.
Recent findings suggest that cleaning the infection and replacing the plastic components of the ankle implant may be slightly more effective than just cleaning the infection alone. This is because these steps can lead to more thorough removal of infected tissue. In cases where patients had infections resulting from bacteria spreading through the bloodstream, both cleaning the infection and replacing the plastic components helped retain the implants in position.
However, the success of this procedure can vary. Some studies have shown a success rate of around 46% when the infection was treated quickly with cleaning and replacing the plastic parts. But if patients had symptoms for a longer time or if the bacteria were resistant to antibiotics, the success rate decreased.
When the infection couldn’t be cleared with cleaning and replacing the plastic parts, the implants often had to be removed in two stages. This means taking out the implant, treating the infection, and then putting in a new implant later. However, this approach might not work as well for ankle implants as it does for hip and knee implants because the ankle has less blood flow and more problems with wound healing.
Sometimes, instead of putting in a new implant, the ankle might be fused together with screws or nails. This is often done when the patient’s overall health is not good, or if there are problems with the blood vessels or soft tissues around the ankle. However, ankle fusion can lead to other issues like differences in leg length or problems in nearby joints.
Overall, if ankle replacement fails and needs to be fixed, the success rate of ankle fusion is around 89%. But some studies have shown that patients might have more pain and less function after ankle fusion compared to when they first had the procedure.
Revision surgery to fix problems with ankle replacement implants has been successful in some cases. Doctors often use special replacement parts designed specifically for revision surgery. While some studies have shown that revision surgery after a failed ankle replacement can have similar results to the first surgery, other studies have found that patients often have ongoing pain even after revision surgery, and in some cases, amputation may be necessary. However, not many studies have looked closely at how well patients can move and function after revision ankle replacement surgery.
In a few cases, doctors have used a temporary cement spacer to treat infections in ankle replacements. Although this can sometimes work well, it’s usually only considered when patients don’t have any symptoms after the spacer is put in, or if they’re not healthy enough for more surgery, or if the tissues around the ankle are damaged. However, there’s a risk that the spacer could become infected over time, just like the original implant did.
In very difficult cases, amputation below the knee may be recommended. This is usually a last resort when other treatments haven’t worked, and it’s done to remove the infected tissue and stop the infection from spreading further.
In summary, while ankle infections after replacement surgery are rare, they can be very serious. Doctors usually try to treat them by cleaning out the infection and giving antibiotics for several weeks. If possible, a two-stage surgery to remove and replace the implant may be done. However, more research is needed to better understand how to treat these infections and improve outcomes for patients.
Do you have more questions?Â
How are infections diagnosed after total ankle replacement surgery?
Infections after total ankle replacement surgery are diagnosed through a combination of clinical assessment, laboratory tests (such as blood tests and joint fluid analysis), and imaging studies (such as X-rays and MRI scans).
What are the risk factors for developing an infection after total ankle replacement surgery?
Risk factors for developing an infection after total ankle replacement surgery include diabetes, obesity, smoking, immunosuppression, previous joint infections, and poor wound healing.
How are infections treated after total ankle replacement surgery?
Infections after total ankle replacement surgery are typically treated with a combination of antibiotics, surgical debridement (cleaning out infected tissue), and, in severe cases, revision surgery to remove and replace the infected components.
Can infections after total ankle replacement surgery lead to complications or implant failure?
Yes, infections after total ankle replacement surgery can lead to complications such as chronic pain, joint instability, bone loss, and implant failure, necessitating additional surgeries and potentially compromising long-term outcomes.
What are the different types of infections that can occur after total ankle replacement surgery?
Different types of infections that can occur after total ankle replacement surgery include superficial skin infections, deep soft tissue infections, and deep joint infections (also known as periprosthetic joint infections or PJIs).
How soon after surgery can infections occur, and what is the typical timeline for their onset?
Infections after total ankle replacement surgery can occur at any time, but they most commonly present within the first few weeks to months after surgery. However, delayed-onset infections can also occur months to years later.
Are there any preventive measures that can reduce the risk of infections after total ankle replacement surgery?
Yes, several preventive measures can reduce the risk of infections after total ankle replacement surgery, including preoperative screening and optimization of medical conditions, perioperative antibiotics, meticulous surgical technique, and postoperative wound care.
How effective are antibiotics in preventing infections after total ankle replacement surgery?
Prophylactic antibiotics given before and/or during surgery are effective in reducing the risk of infections after total ankle replacement surgery, but proper selection, timing, and duration of antibiotic therapy are crucial to prevent complications such as antibiotic resistance.
What is the role of wound care in preventing infections after total ankle replacement surgery?
Proper wound care, including keeping the incision clean and dry, changing dressings as instructed, and monitoring for signs of infection, is essential in preventing infections after total ankle replacement surgery.
Are there any specific precautions or restrictions patients should follow to reduce the risk of infections after total ankle replacement surgery?
Patients should follow their surgeon’s instructions regarding postoperative care, including avoiding submerging the incision in water, refraining from smoking, and adhering to prescribed activity modifications to minimize the risk of infections.
How are infections classified and graded in the context of total ankle replacement surgery?
Infections after total ankle replacement surgery are classified and graded based on various factors such as the timing of onset, microbial pathogens involved, severity of symptoms, and extent of tissue involvement.
Can infections after total ankle replacement surgery spread to other parts of the body or lead to systemic complications?
Yes, infections after total ankle replacement surgery can spread to surrounding tissues, nearby joints, or the bloodstream, causing systemic complications such as sepsis, osteomyelitis, or septic arthritis if not promptly diagnosed and treated.
How do surgeons determine the appropriate treatment approach for infections after total ankle replacement surgery?
Surgeons determine the appropriate treatment approach for infections after total ankle replacement surgery based on factors such as the type and severity of infection, the patient’s overall health, the presence of implant loosening or instability, and the likelihood of achieving successful eradication.
Are there any specific imaging modalities used to diagnose infections after total ankle replacement surgery?
Yes, imaging modalities such as X-rays, CT scans, MRI scans, and nuclear medicine studies (such as bone scans or leukocyte imaging) may be used to diagnose infections after total ankle replacement surgery and assess the extent of soft tissue and bone involvement.
What is the role of joint aspiration or arthrocentesis in diagnosing infections after total ankle replacement surgery?
Joint aspiration or arthrocentesis involves obtaining a sample of joint fluid from the affected ankle to analyze for signs of infection, such as elevated white blood cell count, presence of bacteria, or inflammatory markers, aiding in the diagnosis and management of infections.
Can infections after total ankle replacement surgery be treated with non-surgical methods alone?
Infections after total ankle replacement surgery often require a combination of non-surgical methods (such as antibiotics and close monitoring) and surgical interventions (such as debridement or revision surgery) to effectively eradicate the infection and preserve joint function.
What are the chances of recurrence or reinfection after successfully treating an infection following total ankle replacement surgery?
The chances of recurrence or reinfection after successfully treating an infection following total ankle replacement surgery depend on various factors such as the underlying cause, adequacy of treatment, patient compliance, and ongoing surveillance for complications.
How does the presence of medical comorbidities, such as diabetes or immunosuppression, affect the management and outcomes of infections after total ankle replacement surgery?
Medical comorbidities such as diabetes or immunosuppression can complicate the management and outcomes of infections after total ankle replacement surgery by impairing wound healing, increasing the risk of complications, and compromising the body’s ability to fight infections.
Can infections after total ankle replacement surgery be prevented through the use of antibiotic-coated implants or other advanced techniques?
Antibiotic-coated implants and other advanced techniques such as intraoperative bacterial detection systems or biofilm-targeting therapies show promise in reducing the risk of infections after total ankle replacement surgery, but further research is needed to evaluate their long-term efficacy and safety.
How do surgeons balance the need for aggressive treatment of infections after total ankle replacement surgery with the goal of preserving joint function and minimizing morbidity?
Surgeons balance the need for aggressive treatment of infections after total ankle replacement surgery with the goal of preserving joint function and minimizing morbidity by individualizing treatment plans based on patient-specific factors, infection characteristics, and expected outcomes.
