Two-stage arthrodesis of the ankle joint in the treatment of periprosthetic infection

Kliushin N.M., Ermakov A.M.

Abstract


Introduction
The main reasons for arthroplasty of the ankle joint are osteoarthritis in the terminal stage (posttraumatic or idiopathic), purulent arthritis and oncology. Publications devoted to the problems of infectious complications after arthroplasty of the ankle are not numerous. The rate of periprosthetic ankle infection varies from 2.4 % to 4.7 % of cases; and the predisposing factors include diabetes mellitus, previous history of operations on the joint and the duration of the arthroplasty procedure. The restorative strategy for periprosthetic infection involves diagnostic measures (hematological, radiological, microbiological, radiologic, cytological) and surgical treatment. The variants of surgical treatment of periprosthetic infection of the ankle joint are revision arthroplasty (single- or two-staged), arthrodesis (using external fixation devices and intramedullary nail) and amputation. Moreover, along with surgical intervention, a long-term course of etiotropic therapy (antibacterial and/or antifungal) is mandatory.
Methods
The result of treatment of a patient with periprosthetic ankle infection using a two-stage arthrodesis procedure was analyzed.
Results
The medical measures arrested the purulent inflammatory process and enabled the weight-bearing function of the limb.
Discussion
Two-stage arthrodesis of the ankle may be one of the options for treating periprosthetic infection aimed at maintaining the support function of the limb and its length without the use of additional orthopedic procedures, such as osteotomy for lengthening to cover the post-resection bone defect, thereby reducing the risk of possible complications (damage to the main vessels and nerves in the area of the osteotomy) and the period of surgical rehabilitation of the patient.

Keywords


arthroplasty, ankle joint, periprosthetic infection, spacer, two-stage arthrodesis

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DOI: http://dx.doi.org/10.18019/1028-4427-2020-26-1-99-102

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