What Is the Best Technique for Performing Aspiration of Patients With Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 25S-26S
Author(s):  
Rachel Shakked
Keyword(s):  
Synovial Fluid ◽  
Ankle Joint ◽  
Periprosthetic Joint Infection ◽  
Ultrasound Guidance ◽  
Joint Infection ◽  
Synovial Fluid Sample ◽  
Fluid Sample ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Joint Aspiration

Recommendation: In the absence of evidence, we recommend that ankle joint aspiration to evaluate for periprosthetic joint infection (PJI) be performed under sterile conditions via the anteromedial approach. Ultrasound guidance may be used if available but is not necessary to obtain an acceptable synovial fluid sample. 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)

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)

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)

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).

scholarly journals Synovial fluid interleukin-6 is not superior to cell count and differential in the detection of periprosthetic joint infection

2020 ◽  
Vol 1 (12) ◽  
pp. 737-742
Author(s):  
René Mihalič ◽  
Jurij Zdovc ◽  
Peter Brumat ◽  
Rihard Trebše
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Predictive Performance ◽  
Sinus Tract ◽  
Histopathological Analysis ◽  
Polymorphonuclear Cells ◽  
Level Of Evidence ◽  
Wbc Count ◽  
Sensitivity Specificity

Aims Synovial fluid white blood cell (WBC) count and percentage of polymorphonuclear cells (%PMN) are elevated at periprosthetic joint infection (PJI). Leucocytes produce different interleukins (IL), including IL-6, so we hypothesized that synovial fluid IL-6 could be a more accurate predictor of PJI than synovial fluid WBC count and %PMN. The main aim of our study was to compare the predictive performance of all three diagnostic tests in the detection of PJI. Methods Patients undergoing total hip or knee revision surgery were included. In the perioperative assessment phase, synovial fluid WBC count, %PMN, and IL-6 concentration were measured. Patients were labeled as positive or negative according to the predefined cut-off values for IL-6 and WBC count with %PMN. Intraoperative samples for microbiological and histopathological analysis were obtained. PJI was defined as the presence of sinus tract, inflammation in histopathological samples, and growth of the same microorganism in a minimum of two or more samples out of at least four taken. Results In total, 49 joints in 48 patients (mean age 68 years (SD 10; 26 females (54%), 25 knees (51%)) were included. Of these 11 joints (22%) were infected. The synovial fluid WBC count and %PMN predicted PJI with sensitivity, specificity, accuracy, PPV, and NPV of 82%, 97%, 94%, 90%, and 95%, respectively. Synovial fluid IL-6 predicted PJI with sensitivity, specificity, accuracy, PPV, and NPV of 73%, 95%, 90%, 80%, and 92%, respectively. A comparison of predictive performance indicated a strong agreement between tests. Conclusions Synovial fluid IL-6 is not superior to synovial fluid WBC count and %PMN in detecting PJI. Level of Evidence: Therapeutic Level II Cite this article: Bone Jt Open 2020;1-12:737–742.

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)

What Is the Diagnostic “Algorithm” for Infected Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 21S-22S ◽  
Author(s):  
Nima Heidari ◽  
Irvin Oh ◽  
Francesc Malagelada
Keyword(s):  
Synovial Fluid ◽  
Clinical Symptoms ◽  
Nuclear Imaging ◽  
Diagnostic Algorithm ◽  
Sinus Tract ◽  
Total Ankle Arthroplasty ◽  
High Power Field ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Joint Aspiration

Recommendation: Patients who present with clinical symptoms and signs of periprosthetic ankle infection (pain, erythema, warmth, sinus tract, abscess around the wound) and sinus tracts communicating with the ankle/subtalar joint are likely to have total ankle arthroplasty (TAA) infection. In the absence of a sinus tract, elevated inflammatory markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) should prompt ankle joint aspiration for cell count, differential, and culture. The joint aspiration is to be repeated. If the same organism is identified in at least 2 cultures of synovial fluid, the patient is diagnosed to have an infection. If the repeat aspiration is negative, further investigation is warranted. In patients not requiring operative intervention for other reasons, nuclear imaging should be considered for diagnosis. If an operation is indicated, histologic examination (>5 neutrophils/high-power field) or synovial fluid analysis is conducted to confirm infection. Level of Evidence: Limited. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

scholarly journals Synovial Complement Factors in Patients with Periprosthetic Joint Infection after Undergoing Revision Arthroplasty of the Hip or Knee Joint

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 434
Author(s):  
Frank Sebastian Fröschen ◽  
Sophia Schell ◽  
Matthias Dominik Wimmer ◽  
Gunnar Thorben Rembert Hischebeth ◽  
Hendrik Kohlhof ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Multiple Regression ◽  
Complement System ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Expression Patterns ◽  
Factor H ◽  
Low Grade ◽  
Complement Factors ◽  
Fluid Levels

The role and diagnostic value of the synovial complement system in patients with low-grade periprosthetic joint infection (PJI) are unclear. We sought to evaluate, for the first time, the usefulness of synovial complement factors in these patients by measuring the individual synovial fluid levels of complement factors (C1q, C3b/iC3b, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, properdin, and mannose-binding lectin [MBL]). The patients (n = 74) were classified into septic (n = 28) and aseptic (n = 46). Receiver-operator characteristic curves and a multiple regression model to determine the feasibility of a combination of the tested cytokines to determine the infection status were calculated. The synovial fluid levels of C1q, C3b/C3i, C4b, C5, C5a, MBL, and properdin were significantly elevated in the PJI group. The best sensitivity and specificity was found for C1q. The multiple regression models revealed that the combination of C1q, C3b/C3i, C4b, C5, C5a, and MBL was associated with the best sensitivity (83.3%) and specificity (79.2%) for a cutoff value of 0.62 (likelihood ratio: 4.0; area under the curve: 0.853). Nevertheless, only a combined model showed acceptable results. The expression patterns of the complement factors suggested that PJI activates all three pathways of the complement system.

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