title: The management of infection following total ankle replacement: demographics and treatment.
abstract: BACKGROUND
  Little has been published on the management of infected total ankle replacements. This study reviewed our experience with this difficult clinical problem.
  
  
  METHODS
  From 2002 to 2011 we retrospectively evaluated patients requiring prosthesis removal for infection following primary or revision total ankle replacement. Infections were classified as acute postoperative, late chronic, or remote hematogenous. The demographics, treatment, and outcome of the infected replacements were evaluated.
  
  
  RESULTS
  Of 613 replacements performed during this time period, 15 infections occurred at our institution and 4 from other institutions were treated. These 19 cases included 15 late chronic infections, 3 early postoperative infections, and 1 acute hematogenous infection. Fourteen of the infections occurred in a subset of 433 prostheses (3.2%) placed between 2002 and 2009 when we used an implant with a unique design that necessitated a tibiofibular syndesmosis fusion for the tibial component support (Agility, Depuy). One infection occurred out of 139 other prostheses (0.7%) between 2009 and 2011 when we switched to an anatomic design fixed bearing implant system. Prosthesis salvage was attempted in the 3 early postoperative and 1 acute hematogenous cases, however they all required subsequent removal of the prosthesis. Mean time to removal of the prosthesis after the index arthroplasty was 18 months. Mean follow-up was 19 months from the time of prosthesis removal. Three of the 19 patients underwent successful revision with replacement, 6 with arthrodesis, 7 with a permanent antibiotic spacer, and 3 patients required a transtibial amputation.
  
  
  CONCLUSIONS
  Only a limited number of patients who develop a deep infection following primary or revision total ankle arthroplasty can expect to undergo successful joint-preserving revision ankle arthroplasty.
  
  
  METHODS
  Level III, retrospective case series.
authors.affiliation: Institute for Foot and Ankle Reconstruction at Mercy Medical Centre, Baltimore, MD, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Myerson
authors.affiliation: Institute for Foot and Ankle Reconstruction at Mercy Medical Centre, Baltimore, MD, USA shariffstays@gmail.com.
authors.forename: Raheel
authors.initials: R
authors.lastname: Shariff
authors.affiliation: Upstate Orthopedics, East Syracuse, NY, USA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Zonno
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001174:Arthrodesis / Q000706:statistics & numerical data; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects*; D001843:Bone Cements / Q000627:therapeutic use; D003646:Debridement; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000706:statistics & numerical data; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements
keywords: ankle arthroplasty; infected ankle replacement; management; outcome studies