Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 3S-4S
Author(s):  
Ilker Uçkay ◽  
Christopher B. Hirose ◽  
Mathieu Assal
Keyword(s):  
Periprosthetic Joint Infection ◽  
Corticosteroid Injection ◽  
Joint Infection ◽  
Invasive Procedure ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Strong Consensus ◽  
Healthcare Associated ◽  
The Ideal

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

How Should Postoperative Cellulitis Be Treated in Patients With Total Ankle Arthroplasty (TAA) in Place?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 61S-62S
Author(s):  
Milena M. Plöger ◽  
Christopher D. Murawski
Keyword(s):  
Potential Risk ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Close Monitoring ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Space Infection ◽  
Strong Consensus ◽  
Rule Out

Recommendation: In the absence of evidence, we recommend that (1) patients with total ankle arthroplasty (TAA) in place who develop postoperative cellulitis be evaluated thoroughly to rule out periprosthetic joint infection of the ankle, and that (2) isolated cellulitis may be treated with antibiotics, elevation, and close monitoring. Aspiration can be considered in certain cases, with the potential risk of introducing deep space infection. Level of Evidence: Consensus. Delegate Vote: Agree: 92%, Disagree: 0%, Abstain: 8% (Super Majority, Strong Consensus).

Is There a Role for Measuring Synovial Biomarkers for Diagnosis of Infected Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 27S-29S
Author(s):  
Khaled Emara ◽  
John M. Embil
Keyword(s):  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Positive Culture ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Biomarker Analysis ◽  
Hip And Knee Arthroplasty ◽  
Strong Consensus

Recommendation: Based on the hip and knee arthroplasty literature, measuring synovial biomarkers may play a role in the diagnosis of infected total ankle arthroplasty (TAA). The diagnosis of periprosthetic joint infection (PJI) in the setting of a TAA can be confirmed with cultures, provided that a plausible pathogen is recovered in the context of a compatible clinical picture. In the absence of a positive culture, synovial biomarker analysis may help in establishing the diagnosis. Level of Evidence: Moderate. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

scholarly journals Diagnostic Criteria and Treatment of Acute and Chronic Periprosthetic Joint Infection of Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141984100
Author(s):  
Kempland C. Walley ◽  
Christopher B. Arena ◽  
Paul J. Juliano ◽  
Michael C. Aynardi
Keyword(s):  
Diagnostic Criteria ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Prosthetic Joint ◽  
Ankle Replacement ◽  
Knee And Hip Arthroplasty

Background: Prosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a serious complication that results in significant consequences to the patient and threatens the survival of the ankle replacement. PJI in TAA may require debridement, placement of antibiotic spacer, revision arthroplasty, conversion to arthrodesis, or potentially below the knee amputation. While the practice of TAA has gained popularity in recent years, there is some minimal data regarding wound complications in acute or chronic PJI of TAA. However, of the limited studies that describe complications of PJI of TAA, even fewer studies describe the criteria used in diagnosing PJI. This review will cover the current available literature regarding total ankle arthroplasty infection and will propose a model for treatment options for acute and chronic PJI in TAA. Methods: A review of the current literature was conducted to identify clinical investigations in which prosthetic joint infections occurred in total ankle arthroplasty with associated clinical findings, radiographic imaging, and functional outcomes. The electronic databases for all peer-reviewed published works available through January 31, 2018, of the Cochrane Library, PubMed MEDLINE, and Google Scholar were explored using the following search terms and Boolean operators: “total ankle replacement” OR “total ankle arthroplasty” AND “periprosthetic joint infection” AND “diagnosis” OR “diagnostic criteria.” An article was considered eligible for inclusion if it concerned diagnostic criteria of acute or chronic periprosthetic joint infection of total ankle arthroplasty regardless of the number of patients treated, type of TAA utilized, conclusion, or level of evidence of study. Results: No studies were found in the review of the literature describing criteria for diagnosing PJI specific to TAA. Conclusions: Literature describing the diagnosis and treatment of PJI in TAA is entirely reliant on the literature surrounding knee and hip arthroplasty. Because of the limited volume of total ankle arthroplasty in comparison to knee and hip arthroplasty, no studies to our knowledge exist describing diagnostic criteria specific to total ankle arthroplasty with associated reliability. Large multicenter trials may be required to obtain the volume necessary to accurately describe diagnostic criteria of PJI specific to TAA. Level of Evidence: Level III, systematic review.

What Is the Definition of Acute and Chronic Periprosthetic Joint Infection (PJI) of Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 19S-21S ◽  
Author(s):  
Michael C. Aynardi ◽  
Milena M. Plöger ◽  
Kempland C. Walley ◽  
Christopher B. Arena
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Definition Of ◽  
Knee And Hip Arthroplasty

Recommendation: There is a paucity of data for defining acute or chronic periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA) in the literature. Any discussion of PJI after ankle replacement is entirely reliant on the literature surrounding knee and hip arthroplasty. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Is There a Role for Suppressive Antibiotics in Patients With Periprosthetic Joint Infection (PJI) of Total Ankle Arthroplasty (TAA) Who Have Undergone Surgical Treatment?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 48S-48S
Author(s):  
Selene Parekh
Keyword(s):  
Surgical Treatment ◽  
Antibiotic Therapy ◽  
Operative Treatment ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Ankle Prosthesis ◽  
Routine Administration

Recommendation: Culture-directed antibiotic therapy is recommended for patients undergoing operative treatment of infected total ankle arthroplasty (TAA). Routine administration of suppressive antibiotics in patients with an ankle prosthesis in place is not warranted; however, in certain clinical circumstances, this may be of benefit. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

What Are the Indications for Aspiration of a Possibly Infected Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 24S-25S
Author(s):  
Milena M. Plöeger ◽  
Amiethab Aiyer
Keyword(s):  
Sedimentation Rate ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
C Reactive Protein ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Reactive Protein ◽  
Joint Aspiration ◽  
Erythrocyte Sedimentation

Recommendation: Whenever a periprosthetic joint infection (PJI) of a total ankle arthroplasty (TAA) is clinically possible or suspected, especially when elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels exist, and in correspondence to the literature on PJI in total hip and knee arthroplasties, joint aspiration is indicated. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

What Preoperative Optimization Should Be Implemented to Reduce the Risk of Surgical Site Infection/Periprosthetic Joint Infection (SSI/PJI) in Patients Undergoing Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 6S-8S ◽  
Author(s):  
Khaled Emara ◽  
Christopher B. Hirose ◽  
Ryan Rogero
Keyword(s):  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Site Infection ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Preoperative Optimization ◽  
Control Body ◽  
Skin Cleansing ◽  
Status Enhancement ◽  
Timely Administration

Recommendation: We recommend that patients awaiting total ankle arthroplasty (TAA) be optimized prior to surgery by implementing skin cleansing, nutritional status enhancement, glycemic control, body mass index (BMI) optimization, smoking cessation, and management of immune-modulating comorbidities. At the time of surgery, there is strong evidence that optimal preparation of the surgical site with an alcohol-containing agent, weight-based and timely administration of antibiotic prophylaxis, and reducing operating room traffic should also be put in place. Level of Evidence: Moderate. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

What Prophylactic Antibiotic (Type, Dose and Route of Administration) Should Be Administered Perioperatively for Patients Undergoing Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 8S-9S ◽  
Author(s):  
Marisa Sanchez ◽  
Cecilia Losada
Keyword(s):  
Single Dose ◽  
Joint Infection ◽  
Prophylactic Antibiotic ◽  
Prophylactic Antibiotics ◽  
Total Ankle Arthroplasty ◽  
Site Infection ◽  
Beta Lactam ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Alternative Antibiotic

Recommendation: The administration of prophylactic antibiotics before total ankle arthroplasty (TAA) potentially reduces the incidence of surgical site infection (SSI) and/or periprosthetic joint infection (PJI). Weight-based (of at least 2 g) cefazolin administered intravenously within 60 minutes before the procedure can be an adequate choice for antibiotic prophylaxis. If the patient has a beta-lactam anaphylaxis, we recommend an appropriate alternative antibiotic effective against Staphylococcus. It is unclear whether prophylaxis should be given as a single dose or as multiple doses. Level of Evidence: Strong. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

scholarly journals Outcomes of Acute Hematogenous Periprosthetic Joint Infection in Total Ankle Arthroplasty Treated with Irrigation, Debridement, and Polyethylene Exchange

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
James Lachman ◽  
Jania A. Ramos ◽  
James Nunley ◽  
James DeOrio ◽  
Samuel Adams
Keyword(s):  
Staphylococcus Aureus ◽  
Failure Rate ◽  
Periprosthetic Joint Infection ◽  
Patient Reported Outcomes ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Primary Arthroplasty ◽  
Patient Reported

Category: Ankle Introduction/Purpose: Acute hematogenous periprosthetic joint infection(PJI) is defined in the literature as infection diagnosed and treated within two to four weeks from the onset of symptoms. In total hip and knee arthroplasty, irrigation, debridement(I&D) and polyethylene exchange with component retention is the treatment of choice. There is minimal literature evaluating this treatment method for PJI in total ankle arthroplasty (TAA), however, with four patients being the largest sample size. The purpose of this study was to evaluate both the clinical and patient reported outcomes and survivorship of treating PJI in TAA with I&D and polyethylene exchange in patients with acute hematogenous PJIs. Methods: A single center, retrospective chart review of prospectively collected data in patients with TAA PJI who subsequently underwent I&D and polyethylene exchange with retention of metal components was conducted. The primary outcome was failure rate of I&D and polyethylene exchange where failure was defined as subsequent removal of all components and two-stage revision or arthrodesis. Patient reported outcomes collected before primary arthroplasty, after primary arthroplasty and after polyethylene exchange were also analyzed. Results: We identified 11 patients with acute hematogenous PJI who underwent I&D/ polyethylene exchange with retention of metal components. The average time from onset of symptoms to I&D/ polyethylene exchange was 11.55 days +/-5.57. The mean follow-up after this surgery was 2.8 years +/-1.45. The long-term failure rate was 50%. The most common bacteria isolated in patients who failed was Methicillin Resistant Staphylococcus Aureus (MRSA). The most common bacteria isolated in patients who retained their implants was Methicillin Sensitive Staphylococcus Aureus(MSSA). Visual Analog Scale (VAS), Short Musculoskeletal Function Assessment (SMFA), Short Form-36 (SF36), and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale showed significant improvement when compared to preoperative scores in patients who retained their implants both after primary and after I&D and polyethylene exchange. Conclusion: I&D and polyethylene exchange with retention of metal components has comparable long-term survivorship to those reported in the Knee and Hip Arthroplasty literature. Patient reported outcomes after I&D and polyethylene exchange were comparable to those collected after primary arthroplasty in patients who ultimately retained their implants. Two variables which were independent predictors of failure of this surgery include duration of symptoms prior to I&D as well as organism isolated on culture. With a failure rate of 50%, the authors recommend thorough evaluation on a case by case basis prior to indicating a patient for single stage I&D with polyethylene exchange.

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