Management of the infected total ankle replacement

Infections following total ankle replacement are a serious complication, about which there is little information in the current literature to guide diagnosis and treatment. Infections are classified as acute postoperative, late chronic, or remote hematogenous. Prosthesis removal for infection following primary or revision total ankle replacement along with a thorough debridement and parenteral culture-driven antibiotic therapy is the mainstay of treatment. Only a limited number of patients who develop a deep periprosthetic infection following primary or revision total ankle replacement can expect to undergo successful joint-preserving revision total ankle replacement. Instead, ankle or tibio-talo-calcaneal arthrodesis usually with significant volumes of bone graft is required to obtain a functional limb. Given the morbidity of infected total ankle replacement, careful consideration should be made about performing these procedures in patients with multiple prior surgeries and comorbidities that predispose to wound healing difficulties. Prompt diagnosis and involvement of a multidisciplinary care team are essential to a successful outcome.