Is debridement really the best we can do for periprosthetic joint infections following total ankle replacements? A systematic review and meta-analysis.

Abstract

BACKGROUND\nAnkle periprosthetic joint infections are rising in number, but an evidence-based gold standard treatment has not been defined yet.\n\n\nMETHODS\nWe made a systematic review about the operative treatment of infections following total ankle arthroplasty. Proportional meta-analysis was used to summarize effects of the surgical techniques included. Primary outcome of this study was infection eradication, followed by complications, re-interventions, amputation rates and functions.\n\n\nRESULTS\nWe included six studies(113 patients) reporting 6 types of surgical interventions, mostly irrigation and debridement (35.4%) and two-stage revisions (24.8%). No differences among all analyzed techniques were found in the infection eradication outcome as well as in the secondary outcomes. Patients receiving a permanent spacer are most likely to end up with amputation.\n\n\nCONCLUSIONS\nLiterature dealing with infections after total ankle replacement is currently composed by few low-quality articles. The overlapping of confidence intervals related to all analyzed interventions showed no superiority of either technique.\n\n\nLEVEL OF EVIDENCE\nIII.