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Published in: Archives of Orthopaedic and Trauma Surgery 10/2016

01-10-2016 | Orthopaedic Surgery

Arthrodesis for septic arthritis of the ankle: risk factors and complications

Authors: A. J. Suda, A. Richter, G. Abou-Nouar, M. Jazzazi, M. Tinelli, O. E. Bischel

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2016

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Abstract

Introduction

Septic ankle joint arthrodesis is a good therapeutic option in cases of infection after trauma or orthopedic surgical procedures. Many different procedures have been described, but external fixation seems to be standard. Aim of this study is to identify risk factors for complications in septic ankle joint arthrodesis with the external AO frame fixator.

Materials and methods

Patients who received septic ankle joint arthrodesis between January 2008 and December 2012 were included in this study. Patients were evaluated clinically and with radiographs or CT scans.

Results

Follow-up of 74 of 79 patients with an external AO frame fixator could be evaluated; follow-up was 411 days (105–991). The mean age at surgery was 57.7 years (19–87). At this time, complications occurred in 41 patients (52 %) with wound healing problems (17 patients, 22 %) and non-union (12 patients, 15 %), and some needed surgical revision. In our collective, men had a significant higher non-union rate (p = 0.031), age or BMI showed no difference. Patients with diabetes and alcohol consumption showed a higher risk for complications (p = 0.049 and p = 0.031, respectively). 62 % of primary arthrodesis showed union, whereas in the case of revision, arthrodesis only 39 % showed union.

Conclusions

Septic ankle joint arthrodesis with the external AO frame fixator is a probable tool to achieve union. This study showed that there is a high complication rate and some risk factors for complications could be identified. A blinded and prospective study is needed to compare intramedullary nailing and external fixation to evaluate the possible advantage of intramedullary devices in septic ankle arthrodesis.
Literature
1.
go back to reference Buchner M, Sabo D (2003) Vergleich zwischen externer und interner Fixation bei Arthrodese des oberen Sprunggelenks. Perioperative und langfristige Ergebnisse. Unfallchirurg 106(6):472–477CrossRefPubMed Buchner M, Sabo D (2003) Vergleich zwischen externer und interner Fixation bei Arthrodese des oberen Sprunggelenks. Perioperative und langfristige Ergebnisse. Unfallchirurg 106(6):472–477CrossRefPubMed
2.
go back to reference Cheng YM, Chen SK, Chen JC et al (2003) Revision of ankle arthrodesis. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 24(4):321–325 Cheng YM, Chen SK, Chen JC et al (2003) Revision of ankle arthrodesis. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 24(4):321–325
3.
go back to reference Endres T, Grass R, Rammelt S, Zwipp H (2005) Die Vier-Schrauben-Arthrodese des oberen Sprunggelenks. Oper Orthop Traumatol 17(4–5):345–360CrossRefPubMed Endres T, Grass R, Rammelt S, Zwipp H (2005) Die Vier-Schrauben-Arthrodese des oberen Sprunggelenks. Oper Orthop Traumatol 17(4–5):345–360CrossRefPubMed
4.
go back to reference Ettinger S, Stukenborg-Colsman C, Plaass C et al (2016) Tibiocalcaneal arthrodesis as a limb salvage procedure for complex hindfoot deformities. Arch Orthop Trauma Surg 136(4):457–462CrossRefPubMed Ettinger S, Stukenborg-Colsman C, Plaass C et al (2016) Tibiocalcaneal arthrodesis as a limb salvage procedure for complex hindfoot deformities. Arch Orthop Trauma Surg 136(4):457–462CrossRefPubMed
5.
go back to reference Frey C, Halikus NM, Vu-Rose T, Ebramzadeh E et al (1994) A review of ankle arthrodesis: predisposing factors to nonunion. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 15(11):581–584CrossRef Frey C, Halikus NM, Vu-Rose T, Ebramzadeh E et al (1994) A review of ankle arthrodesis: predisposing factors to nonunion. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 15(11):581–584CrossRef
6.
go back to reference Gessmann J, Ozokyay L, Fehmer T, Muhr G, Seybold D (2011) Die Arthrodese des Sprunggelenks in Infektsituationen: Ergebnisse mit dem Ilizarov-Ringfixateur. Z fur Orthop Unfallchirurgie 149(2):212–218 Gessmann J, Ozokyay L, Fehmer T, Muhr G, Seybold D (2011) Die Arthrodese des Sprunggelenks in Infektsituationen: Ergebnisse mit dem Ilizarov-Ringfixateur. Z fur Orthop Unfallchirurgie 149(2):212–218
7.
go back to reference Goebel M, Muckley T, Gerdesmeyer L, Militz M, Buhren V (2003) Die kombinierte Kompressionsmarknagelarthrodese von OSG und USG. Unfallchirurg 106(8):633–641CrossRefPubMed Goebel M, Muckley T, Gerdesmeyer L, Militz M, Buhren V (2003) Die kombinierte Kompressionsmarknagelarthrodese von OSG und USG. Unfallchirurg 106(8):633–641CrossRefPubMed
8.
go back to reference Grass R, Rammelt S, Endres T, Zwipp H (2005) Reorientierende Arthrodese des oberen Sprunggelenks in der 4-Schrauben-Technik. Der Orthop 34(12):1209–1215CrossRef Grass R, Rammelt S, Endres T, Zwipp H (2005) Reorientierende Arthrodese des oberen Sprunggelenks in der 4-Schrauben-Technik. Der Orthop 34(12):1209–1215CrossRef
9.
go back to reference Hulscher JB, te Velde EA, Schuurman AH, Hoogendoorn JM, Kon M, van der Werken C (2001) Arthrodesis after osteosynthesis and infection of the ankle joint. Injury 32(2):145–152CrossRefPubMed Hulscher JB, te Velde EA, Schuurman AH, Hoogendoorn JM, Kon M, van der Werken C (2001) Arthrodesis after osteosynthesis and infection of the ankle joint. Injury 32(2):145–152CrossRefPubMed
10.
go back to reference Hulsker CC, Kleinveld S, Zonnenberg CB, Hogervorst M, van den Bekerom MP (2011) Evidence-based treatment of open ankle fractures. Arch Orthop Trauma Surg 131(11):1545–1553CrossRefPubMedPubMedCentral Hulsker CC, Kleinveld S, Zonnenberg CB, Hogervorst M, van den Bekerom MP (2011) Evidence-based treatment of open ankle fractures. Arch Orthop Trauma Surg 131(11):1545–1553CrossRefPubMedPubMedCentral
11.
go back to reference Jehan S, Shakeel M, Bing AJ, Hill SO (2011) The success of tibiotalocalcaneal arthrodesis with intramedullary nailing: a systematic review of the literature. Acta Orthop Belg 77(5):644–651PubMed Jehan S, Shakeel M, Bing AJ, Hill SO (2011) The success of tibiotalocalcaneal arthrodesis with intramedullary nailing: a systematic review of the literature. Acta Orthop Belg 77(5):644–651PubMed
12.
go back to reference Kappler C, Staubach R, Abdulazim A, Kemmerer M, Walter G, Hoffmann R (2013) Die Rückfussarthrodese bei postinfektioser Sprunggelenkdestruktion mit einem intramedullaren retrograden Arthrodesennagel. Unfallchirurg Kappler C, Staubach R, Abdulazim A, Kemmerer M, Walter G, Hoffmann R (2013) Die Rückfussarthrodese bei postinfektioser Sprunggelenkdestruktion mit einem intramedullaren retrograden Arthrodesennagel. Unfallchirurg
13.
go back to reference Kienast B, Kiene J, Gille J, Thietje R, Gerlach U, Schulz AP (2010) Posttraumatic severe infection of the ankle joint-long term results of the treatment with resection arthrodesis in 133 cases. European journal of medical research 15(2):54–58CrossRefPubMedPubMedCentral Kienast B, Kiene J, Gille J, Thietje R, Gerlach U, Schulz AP (2010) Posttraumatic severe infection of the ankle joint-long term results of the treatment with resection arthrodesis in 133 cases. European journal of medical research 15(2):54–58CrossRefPubMedPubMedCentral
14.
go back to reference Klouche S, El-Masri F, Graff W, Mamoudy P (2011) Arthrodesis with internal fixation of the infected ankle. J foot Ankle Surg Off Publ Am Coll Foot Ankle Surg 50(1):25–30 Klouche S, El-Masri F, Graff W, Mamoudy P (2011) Arthrodesis with internal fixation of the infected ankle. J foot Ankle Surg Off Publ Am Coll Foot Ankle Surg 50(1):25–30
15.
go back to reference Kollig E, Esenwein SA, Muhr G, Kutscha-Lissberg F (2003) Fusion of the septic ankle: experience with 15 cases using hybrid external fixation. J Trauma 55(4):685–691CrossRefPubMed Kollig E, Esenwein SA, Muhr G, Kutscha-Lissberg F (2003) Fusion of the septic ankle: experience with 15 cases using hybrid external fixation. J Trauma 55(4):685–691CrossRefPubMed
16.
go back to reference Labitzke R (2005) Die sog. Seilarthrodese des oberen Sprunggelenks. Oper Orthop Traumatol 17(4–5):392–406CrossRefPubMed Labitzke R (2005) Die sog. Seilarthrodese des oberen Sprunggelenks. Oper Orthop Traumatol 17(4–5):392–406CrossRefPubMed
17.
go back to reference Mäenpää H, Lehto MU, Belt EA (2001) Why do ankle arthrodeses fail in patients with rheumatic disease? Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 22(5):403–408 Mäenpää H, Lehto MU, Belt EA (2001) Why do ankle arthrodeses fail in patients with rheumatic disease? Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 22(5):403–408
18.
go back to reference Midis N, Conti SF (2002) Revision ankle arthrodesis. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 23(3):243–247 Midis N, Conti SF (2002) Revision ankle arthrodesis. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 23(3):243–247
19.
go back to reference Mückley T, Hofmann G, Buhren V (2005) Die tibiotalare Arthrodese mit dem Kompressionsmarknagel. Oper Orthop Traumatol 17(4–5):407–425CrossRefPubMed Mückley T, Hofmann G, Buhren V (2005) Die tibiotalare Arthrodese mit dem Kompressionsmarknagel. Oper Orthop Traumatol 17(4–5):407–425CrossRefPubMed
20.
go back to reference Myers TG, Lowery NJ, Frykberg RG, Wukich DK (2012) Ankle and hindfoot fusions: comparison of outcomes in patients with and without diabetes. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 33(1):20–28CrossRef Myers TG, Lowery NJ, Frykberg RG, Wukich DK (2012) Ankle and hindfoot fusions: comparison of outcomes in patients with and without diabetes. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 33(1):20–28CrossRef
21.
go back to reference Perlman MH, Thordarson DB (1999) Ankle fusion in a high risk population: an assessment of nonunion risk factors. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 20(8):491–496CrossRef Perlman MH, Thordarson DB (1999) Ankle fusion in a high risk population: an assessment of nonunion risk factors. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 20(8):491–496CrossRef
22.
go back to reference Pountos I, Georgouli T, Calori GM, Giannoudis PV (2012) Do nonsteroidal anti-inflammatory drugs affect bone healing? A critical analysis. Sci World J 2012:606404CrossRef Pountos I, Georgouli T, Calori GM, Giannoudis PV (2012) Do nonsteroidal anti-inflammatory drugs affect bone healing? A critical analysis. Sci World J 2012:606404CrossRef
23.
go back to reference Richter D, Hahn MP, Laun RA, Ekkernkamp A, Muhr G, Ostermann PA (1999) Arthrodesis of the infected ankle and subtalar joint: technique, indications, and results of 45 consecutive cases. J Trauma 47(6):1072–1078CrossRefPubMed Richter D, Hahn MP, Laun RA, Ekkernkamp A, Muhr G, Ostermann PA (1999) Arthrodesis of the infected ankle and subtalar joint: technique, indications, and results of 45 consecutive cases. J Trauma 47(6):1072–1078CrossRefPubMed
24.
go back to reference Rochman R, Jackson Hutson J, Alade O (2008) Tibiocalcaneal arthrodesis using the Ilizarov technique in the presence of bone loss and infection of the talus. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 29(10):1001–1008CrossRef Rochman R, Jackson Hutson J, Alade O (2008) Tibiocalcaneal arthrodesis using the Ilizarov technique in the presence of bone loss and infection of the talus. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 29(10):1001–1008CrossRef
25.
go back to reference Schmidt HG, Hadler D, Gerlach UJ, Schoop R (2005) Prinzipien der OSG-Arthrodese bei Gelenkinfekt. Der Orthopade 34(12):1216–1228CrossRefPubMed Schmidt HG, Hadler D, Gerlach UJ, Schoop R (2005) Prinzipien der OSG-Arthrodese bei Gelenkinfekt. Der Orthopade 34(12):1216–1228CrossRefPubMed
26.
go back to reference Scranton PE Jr (1991) An overview of ankle arthrodesis. Clin Orthop Relat Res 286:96–101 Scranton PE Jr (1991) An overview of ankle arthrodesis. Clin Orthop Relat Res 286:96–101
27.
go back to reference Thevendran G, Younger A, Pinney S (2012) Current concepts review: risk factors for nonunions in foot and ankle arthrodeses. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 33(11):1031–1040CrossRef Thevendran G, Younger A, Pinney S (2012) Current concepts review: risk factors for nonunions in foot and ankle arthrodeses. Foot Ankle Int Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc 33(11):1031–1040CrossRef
Metadata
Title
Arthrodesis for septic arthritis of the ankle: risk factors and complications
Authors
A. J. Suda
A. Richter
G. Abou-Nouar
M. Jazzazi
M. Tinelli
O. E. Bischel
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-016-2520-y

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