Foot and Ankle International - 2026-03-27 - Journal Article
Periprosthetic Joint Infection in Total Ankle Arthroplasty: An Exploratory Analysis of Outcomes and Challenges Persisting in Treatment.
Teehan E, Braswell MJ, Lu K, Karas E, Henry M, Henry JK, Demetracopoulos CA
Topics
Key Takeaway
PJI after TAA occurred at 1.3% (12/955 patients, 5.4 per 1000 person-years), with only 50% overall implant retention and 2 of 5 chronic PJI patients ultimately requiring below-knee amputation.
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Summary
This single-institution retrospective study identified 12 PJI cases among 955 primary TAA patients using MSIS criteria, comparing outcomes between acute (<4 weeks) and chronic (≥4 weeks) PJI. DAIR achieved implant retention in 4/5 acute cases but only 2/7 chronic cases. Among chronic PJI failures, 2 patients required below-knee amputation, 1 underwent tibiotalocalcaneal arthrodesis, and 1 ankle arthrodesis, yielding a 50% overall implant retention rate.
Key Limitation
The 12-patient PJI cohort is underpowered to support any comparative treatment conclusions, making all reported retention and amputation rates descriptive estimates with wide confidence intervals.
Original Abstract
BACKGROUND
Periprosthetic joint infection (PJI) remains an uncommon but devastating complication after total ankle arthroplasty (TAA). Literature investigating treatment of PJI in TAA is limited, demonstrating poor patient-reported outcomes and high rates of complications and reoperations. Therefore, continued investigation of PJI treatment following TAA is necessary. This exploratory study describes clinical, microbiological, and patient-reported outcomes for PJI treatment following TAA at minimum 2-year follow-up.
METHODS
Retrospective chart review was conducted for a single-institution registry of primary TAA patients between January 2015 and December 2021 with at least 1 follow-up appointment. Patients with PJI were identified using Musculoskeletal Infection Society (MSIS) criteria. Acute vs chronic PJI was defined as infectious symptom duration of <4 weeks and ≥4 weeks, respectively. Clinical, radiographic, microbiologic, and patient-reported outcomes were collected for PJI patients. The primary outcome was maintenance of a functioning TAA implant at the most recent follow-up; the secondary outcome was successful limb salvage.
RESULTS
Of the 955 patients included in this analysis, 12 (1.3%) underwent reoperation for PJI at median 5.7-year follow-up, with 5 acute and 7 chronic PJI patients. The PJI incidence rate was 5.4 per 1000 person-years at risk (95% CI: 2.8, 9.5). Implant retention rate was 50% across all PJI patients, including 4 of 5 acute and 2 of 7 chronic PJI patients. One acute PJI patient underwent explant with permanent cement spacer. Chronic PJI patients without functioning TAA implant at final follow-up had undergone permanent cement spacer with washouts (n = 1), tibiotalocalcaneal arthrodesis (n = 1), ankle arthrodesis (n = 1), and below-knee amputation (n = 2).
CONCLUSION
Debridement, antibiotics, and implant retention (DAIR) appears to be a viable option for acute PJI treatment. However, DAIR and explant with staged revision may be insufficient for complete eradication of chronic PJI. Infection recurrence may result in permanent loss of function because of limited secondary treatment options after failed revision.