What Is the Diagnostic "Algorithm" for Infected Total Ankle Arthroplasty (TAA)?

RECOMMENDATION

Patients who present with clinical symptoms and signs of periprosthetic ankle infection (pain, erythema, warmth, sinus tract, abscess around the wound) and sinus tracts communicating with the ankle/subtalar joint are likely to have total ankle arthroplasty (TAA) infection. In the absence of a sinus tract, elevated inflammatory markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) should prompt ankle joint aspiration for cell count, differential, and culture. The joint aspiration is to be repeated. If the same organism is identified in at least 2 cultures of synovial fluid, the patient is diagnosed to have an infection. If the repeat aspiration is negative, further investigation is warranted. In patients not requiring operative intervention for other reasons, nuclear imaging should be considered for diagnosis. If an operation is indicated, histologic examination (>5 neutrophils/high-power field) or synovial fluid analysis is conducted to confirm infection.

LEVEL OF EVIDENCE

Limited.

DELEGATE VOTE

Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).