Capece Giacomo, Di Gialleonardo Emidio, Comisi Chiara, Bocchino Guido, Cinelli Virginia, Mascio Antonio, Fulchignoni Camillo, Greco Tommaso, Maccauro Giulio, Perisano Carlo
Orthopaedics and Trauma Surgery Unit, Catholic University of The Sacred Heart, 00168 Rome, Italy.
U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy.
J Clin Med. 2025 Jan 23;14(3):718. doi: 10.3390/jcm14030718.
: This comprehensive systematic review aims to explore and discuss existing treatment modalities for infections in total ankle arthroplasty (TAA), providing insights that may contribute to the establishment of a "standard of care" for these challenging cases. The study analyses the intricate landscape of infected TAA, addressing gaps in the current literature and emphasizing the need to refine treatment strategies. With the reported incidence of periprosthetic joint infection after TAA surpassing rates observed in total hip and knee replacements, the research navigates through various treatment modalities, underscoring the lack of a universally accepted standard of care. : In this systematic review, following PRISMA guidelines, PubMed, Scopus, and Google Scholar, we identified 15 papers addressing the management strategies for infected TAA (162 infected ankle arthroplasty cases).These databases were chosen for their extensive coverage, strong relevance to the research topic, and ease of access, ensuring a thorough and focused retrieval of pertinent literature on the treatment of infected ankle prostheses. The review involved the identification and evaluation of articles providing insights into complications, treatment outcomes, and risk factors. Extracted data were summarized and reported. A descriptive analysis was performed, and when feasible, a statistical analysis was conducted. : Treatment modalities included irrigation and debridement (48.8%), revision total ankle arthroplasty (36.3%), primary arthrodesis (7.9%), spacer arthroplasty (4.5%), and primary amputation (3.9%). Complication rates varied, with 46.5% for irrigation and debridement, 20% for two-stage revision, 7.14% for primary arthrodesis, and 25% for spacer arthroplasty. : The rising prevalence of TAA underscores the need for a definitive treatment protocol due to severe complications. This review emphasizes careful patient selection and accurate diagnosis. Irrigation and debridement are effective for acute infections, while two-stage revision is a valid alternative for chronic infections. High-quality randomized controlled trials are important for establishing an evidence-based treatment protocol.
本全面的系统评价旨在探索和讨论全踝关节置换术（TAA）感染的现有治疗方式，提供有助于为这些具有挑战性的病例建立“护理标准”的见解。该研究分析了感染性TAA的复杂情况，指出当前文献中的空白，并强调完善治疗策略的必要性。鉴于报道的TAA后假体周围关节感染发生率超过全髋关节和膝关节置换术的发生率，该研究探讨了各种治疗方式，强调缺乏普遍接受的护理标准。
在本系统评价中，我们遵循PRISMA指南，通过PubMed、Scopus和谷歌学术搜索，确定了15篇论述感染性TAA管理策略的论文（162例感染性踝关节置换病例）。选择这些数据库是因为它们覆盖范围广泛、与研究主题相关性强且易于访问，确保全面且有针对性地检索有关感染性踝关节假体治疗的相关文献。该评价涉及识别和评估提供并发症、治疗结果和危险因素见解的文章。提取的数据进行了总结和报告。进行了描述性分析，并在可行时进行了统计分析。
治疗方式包括冲洗清创术（48.8%）、翻修全踝关节置换术（36.3%）、一期关节融合术（7.9%）、间隔物置换术（4.5%）和一期截肢术（3.9%）。并发症发生率各不相同，冲洗清创术为46.5%，二期翻修为20%，一期关节融合术为7.14%，间隔物置换术为25%。
由于严重并发症，TAA患病率的上升凸显了制定明确治疗方案的必要性。本评价强调仔细的患者选择和准确的诊断。冲洗清创术对急性感染有效，而二期翻修是慢性感染的有效替代方案。高质量的随机对照试验对于建立循证治疗方案很重要。
