Outcomes of One-Stage Arthroscopic Ankle and Tibiotalocalcaneal Arthrodesis with External Fixation for Septic Ankle and Hindfoot Arthritis: A Case-Series Study

Abstract

Objectives: The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study was to investigate the outcomes of one-stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis with external fixation in the treatment of septic ankle and hindfoot arthritis.

Methods: A retrospective consecutive case-series study was conducted involving six patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one-stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow-up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Comparisons of AOFAS ankle-hindfoot score and VAS pain score between preoperative measures and those at the final follow-up were conducted using paired t-tests or paired Wilcoxon rank-sum tests.

Results: The study cohort comprised two males and four females, with a mean age of 48.7 years (range, 26–75) at the time of surgical intervention. At the final follow-up (mean, 26.5 months; range, 16–48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12–57) to 80.0 (range, 54–92) (p = 0.007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4–9) to 0 (range, 0–5) (p = 0.046). All patients had achieved osseous consolidation, with a hindfoot infection control rate of 100%.

Conclusion: One-stage arthroscopic ankle and TTC arthrodesis with external fixation is as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.

Keywords

Arthrodesis / Arthroscopy / Hindfoot / Septic Arthritis

References

[1] Hong Y, Jung K, Chang H, Yeo E, Lee H, Won S, et al. Staged joint arthrodesis in the treatment of severe septic ankle arthritis sequelae: acase report. Int J Environ Res Public Health. 2021; 18(23): 12473.

[2] Simoni G, Maccauro G, Fenga D, DeSantis V, Orani RA, Centofanti F, et al. Arthrodesis of the ankle joint in septic osteoarthritis: six years long term outcomes in authors’ personal experience. Eur Rev Med Pharmacol Sci. 2019; 23(2 Suppl): 139–144.

[3] Perez-Prieto D, Portillo ME, Gonzalez-Lucena G, Gines-Cespedosa A. Foot and ankle infections: debridement, early fixation and rifampicin provideearlier recovery of function and quality of life. Foot Ankle Surg. 2019; 25(1): 13–18.

[4] Kienast B, Kiene J, Gille J, Thietje R, Gerlach U, Schulz AP. Posttraumatic severe infection of the ankle joint -long term results of thetreatment with resection arthrodesis in 133 cases. Eur J Med Res. 2010; 15(2): 54–58.

[5] Mankovecky MR, Roukis TS. Arthroscopic Synovectomy, irrigation, and debridement for treatment of septic ankle arthrosis: asystematic review and case series. J Foot Ankle Surg. 2014; 53(5): 615–619.

[6] Hulscher JBF, Te Velde EA, Schuurman AH, Hoogendoorn JM, Kon M, van der Werken C. Arthrodesis after osteosynthesis and infection of the ankle joint. Injury. 2001; 32(2): 145–152.

[7] Suda AJ, Richter A, Abou-Nouar G, Jazzazi M, Tinelli M, Bischel OE. Arthrodesis for septic arthritis of the ankle: risk factors and complications. Arch Orthop Trauma Surg. 2016; 136(10): 1343–1348.

[8] Hartmann R, Grubhofer F, Waibel FWA, Götschi T, Viehöfer AF, Wirth SH. Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis. J Orthop Res. 2021; 39(10): 2151–2158.

[9] Kollig E, Esenwein SA, Muhr G, Kutscha-Lissberg F. Fusion of the septic ankle: experience with 15 cases using hybrid external fixation. J Trauma. 2003; 55(4): 685–691.

[10] Ramamurti P, Agarwal AR, Gu A, Fassihi SC, Probasco WV, Quan T, et al. Increased risk of 90-day surgical-site infection and hospital readmission but not reoperation after open Arthrotomy when compared with arthroscopy for septic ankle arthritis. Arthroscopy: the journal of Arthroscopic & Related. Surgery. 2022; 38(6): 1999–2006.

[11] Movassaghi K, Wakefield C, Bohl DD, Lee S, Lin J, Holmes GB, et al. Septic arthritis of the native ankle. JBJS Rev. 2019; 7(3): e6.

[12] Mercurio M, Castioni D, Porco E, Familiari F, Gasparini G, Galasso O. Periprosthetic ankle infection: eradication rate, complications, and limbsalvage. A systematic review. Foot Ankle Surg. 2022; 28(5): 550–556.

[13] Gee C, Tandon T, Avasthi A, Jerwood S, Rao BM, Cavanagh S. Primary meningococcal septic arthritis of the ankle joint: acase report. J Foot Ankle Surg. 2014; 53(2): 216–218.

[14] Solow M, Sarraj M, Johal H, Al-Asiri J. A case report of pneumococcal septic arthritis following a respiratory and gastrointestinal Prodrome with accompanying literature review. J Foot Ankle Surg. 2019; 58(6): 1293–1297.

[15] Baumbach SF, Massen FK, Hörterer S, Braunstein M, Waizy H, Böcker W, et al. Comparison of arthroscopic to open tibiotalocalcaneal arthrodesis in high-risk patients. Foot Ankle Surg. 2019; 25(6): 804–811.

[16] Martinelli N, Bianchi A, Raggi G, Parrini MM, Cerbone V, Sansone V. Open versus arthroscopic ankle arthrodesis in high-risk patients: a comparativestudy. Int Orthop. 2022; 46(3): 515–521.

[17] Gutteck N, Delank KS, Schilde S. Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis inpatients with diabetes-associated Charcot Neuro-Arthropathy. Eur J Orthop Surg Traumatol. 2023; 33(8): 3577–3584.

[18] Stutz G, Kuster MS, Kleinstück F, Gächter A. Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc. 2000; 8(5): 270–274.

[19] Aïm F, Delambre J, Bauer T, Hardy P. Efficacy of arthroscopic treatment for resolving infection in septic arthritis of native joints. Orthop Traumatol Surg Res. 2015; 101(1): 61–64.

[20] Boffeli TJ, Thompson JC. Arthroscopic Management of the Septic Ankle Joint: case report of a stage-guided treatment. J Foot Ankle Surg. 2013; 52(1): 113–117.

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.