1st Orthopaedic and Traumatologic Clinic, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy.
Eur Rev Med Pharmacol Sci. 2019 Apr;23(2 Suppl):159-172. doi: 10.26355/eurrev_201904_17486.
We performed a systematic review of surgical treatment of the infected total ankle arthroplasty. The purpose of this investigation was to describe the current trends and to perform a critical analysis of the evidence reported in the existing literature.
A comprehensive search for all relevant articles published in English was conducted. Scientific databases were accessed to identify papers dealing with the management of the infected total ankle arthroplasty. We identified and collected every patient that underwent a surgical management of infected ankle arthroplasty. Data extracted were summarized and reported. A descriptive analysis was performed; when possible, a statistical analysis was accomplished.
Thirty-two papers (152 infected ankle arthroplasty) published in the last 20 years were identified. Twenty-seven patients (17.76%) were treated with irrigation and debridement, revision total ankle arthroplasty was performed in 72 cases (47.37%), arthrodesis was performed as a primary treatment in 30 patients (19.74%), 12 patients (7.89%) underwent a spacer arthroplasty while amputation was performed as a primary treatment in 9 patients (5.92%).
Our study reveals the improvement of the surgical management of the infected total ankle arthroplasty through the last 20 years. Irrigation and debridement and two-stage revision represent the most viable treatment in acute postoperative and late chronic infections respectively. We noted a trend towards maintaining articularity through a two-stage revision. The quality of evidence is weak with biases both in reporting and selection process. High quality randomized controlled trials are required to compare different treatments in order to introduce an evidence-based treatment protocol.
我们对感染性全踝关节置换术的手术治疗进行了系统评价。本研究旨在描述当前的趋势，并对现有文献中报告的证据进行批判性分析。
对所有以英文发表的相关文章进行了全面检索。访问科学数据库以确定涉及感染性全踝关节置换术处理的论文。我们确定并收集了每例接受感染性踝关节置换术手术治疗的患者。提取的数据进行了总结和报告。进行了描述性分析；在可能的情况下，完成了统计分析。
在过去的 20 年中，确定了 32 篇论文（152 例感染性踝关节置换术）。27 例（17.76%）患者接受灌洗清创术治疗，72 例（47.37%）行全踝关节翻修术，30 例（19.74%）作为主要治疗方法行踝关节融合术，12 例（7.89%）行间隔器置换术，9 例（5.92%）作为主要治疗方法行截肢术。
我们的研究表明，在过去的 20 年中，感染性全踝关节置换术的手术治疗得到了改善。灌洗清创术和二期翻修术分别是急性术后和晚期慢性感染的最可行治疗方法。我们注意到通过二期翻修保持关节连续性的趋势。证据质量较差，报告和选择过程均存在偏倚。需要高质量的随机对照试验来比较不同的治疗方法，以引入基于证据的治疗方案。
