Foot & Ankle

What to do for post-infection arthritis?

Arthroplasty in the context of a previously infected joint is controversial at the best of times – but often necessary. In the case of the ankle joint, this has long been regarded as contraindicated – the combination of relatively poor longevity and difficulty of revision has long put surgeons off arthroplasty in the face of infection. However, it is not quite clear why, other than a natural conservatism with regards to ankle replacements. Surgeons from Duke University Durham (USA) present their results from a series of 22 total ankle arthroplasties (TAAs),⁴ which will certainly cause this question to be re-examined. These plucky surgeons implanted 22 ankle replacements in the face of previous septic arthritis and report their results. It is worth noting that these cases had an average of eight years’ infection-free interval prior to surgery. As with most data relating to ankle arthroplasty, the numbers are small and the patient group relatively heterogeneous with a range of comorbidities relevant to the outcome of the surgery. At the reported two year follow-up there was no evidence of reactivation of infection in any of the 22 implanted joints; encouraging data indeed. The authors include some sage caveats to interpreting these results and point out that the decision to proceed was made in light of their clinical impression of the soft tissues and other relevant patient factors. It seems that the success of this procedure in the setting of previous infection relies heavily on clinical acumen and good decision-making.