PMID- 36136051 OWN - NLM STAT- MEDLINE DCOM- 20230322 LR - 20240402 IS - 1528-1132 (Electronic) IS - 0009-921X (Print) IS - 0009-921X (Linking) VI - 481 IP - 4 DP - 2023 Apr 1 TI - Is Ankle Arthrodesis With an Ilizarov External Fixator an Effective Treatment for Septic Ankle Arthritis? A Study With a Minimum of 6 Years of Follow-up. PG - 717-725 LID - 10.1097/CORR.0000000000002418 [doi] AB - BACKGROUND: Septic ankle arthritis is a devastating clinical problem with a high potential for permanent disability and amputation. Successful treatment of septic ankle arthritis remains a challenge for the surgeon and patient. Ankle arthrodesis combined with radical debridement may be an effective option to eradicate infection and salvage the limb. Although numerous fusion methods have been proposed, there is controversy about the most effective technique. QUESTIONS/PURPOSES: At a minimum follow-up of 6 years after ankle arthrodesis performed using an Ilizarov external fixator, we asked, (1) In what proportion of patients was bony fusion achieved? (2) What complications were observed, and what reoperations were performed in these patients? (3) How much did patient-reported outcomes improve from before surgery to the most recent follow-up in this group? METHODS: Between April 2010 to March 2015, we treated 59 patients for septic ankle arthritis. Of those, we considered patients who were at least 18 years of age with irreversible destruction of the joint as potentially eligible. During that time period, all patients met the prespecified criteria and were treated with ankle arthrodesis using an Ilizarov external fixator. Two percent (one of 59) of patients were excluded because they died in the second year after surgery for reasons unrelated to the procedure, and another 7% (four of 59) of patients were excluded because they were lost before the minimum study follow-up interval of 6 years. Finally, 92% (54 of 59) of patients were analyzed at a mean follow-up time of 9 +/- 1 years. A total of 61% (33 of 54) were men, and they had a mean age of 48 +/- 12 years. Forty-six percent (25 of 54) of patients were smokers, and 13% (seven of 54) of patients had Type 2 diabetes mellitus. All patients received radical debridement and primary arthrodesis with an Ilizarov external fixator, followed by antibiotic therapy. Postoperatively, patients were instructed to perform lower extremity functional exercises and external fixator care; weightbearing ambulation as tolerated was encouraged as early as possible. Fusion was assessed with a radiographic review that was performed by an individual who was not involved in the surgical care of these patients. We defined bony fusion as continuous trabeculae and complete cortical bridging in the fusion interface achieved before 9 months; delayed union was defined as fusion achieved by 9 to 12 months; and nonunion was defined as patients in whom fusion was not achieved by 12 months. Complications and reoperations were tallied through a record review that was performed by an individual who was not involved in the surgical care of these patients. We defined complications as any deviation from the expected postoperative course. We used the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the VAS active pain score, and the SF-12 questionnaire (including the physical component summary [PCS] score and mental component summary [MCS] score) to assess patient-reported outcomes. The minimum clinically important difference (MCID) for the AOFAS score was 30 points of 100, the MCID for the VAS active pain score was 2 points of 10, and the MCID of PCS and MCS scores was 7 points and 9 points, respectively. RESULTS: Primary bony fusion was achieved in 94% (51 of 54) of patients. Delayed union was found in 2% (one of 54) of patients. Nonunion was found in 6% (three of 54); one of these patients underwent autologous bone grafting during revision, and bony fusion was ultimately achieved. Final bony fusion was achieved in 96% (52 of 54) of patients. Recurrent infection was found in 2% (one of 54). The median (range) AOFAS score improved from 28 points (8 to 59) before surgery to 80 points (52 to 86) at the most recent follow-up (median difference 52; p < 0.001). The median (range) VAS active pain score decreased from 8 points (6 to 9) before surgery to 2 points (0 to 5) at the most recent follow-up (median difference -6; p < 0.001). For the Short Form 12-item score, the median (range) PCS score improved from 0 points (0 to 30) before surgery to 70 points (40 to 95) at the most recent follow-up (median difference 70; p < 0.001), and the median (range) MCS score improved from 46 points (21 to 75) before surgery to 75 points (50 to 92) at the most recent follow-up (median difference 29; p < 0.001). CONCLUSION: Ankle arthrodesis with Ilizarov external fixation might eradicate an infection and restore foot function in patients with septic ankle arthritis. However, patients should be fully informed of the complications related to the external fixator, such as pin-tract infections, recurrent infection, and nonunion. Standardized and professional pin care is important. Additionally, because Ilizarov external fixators can be inconvenient to the patients' daily lives, future studies should explore how psychologic support affects patients who undergo ankle arthrodesis with these devices. LEVEL OF EVIDENCE: Level IV, therapeutic study. CI - Copyright (c) 2022 by the Association of Bone and Joint Surgeons. FAU - Wang, Shanxi AU - Wang S AD - Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China. AD - Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China. FAU - Li, Bohua AU - Li B AD - Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China. FAU - Yu, Xiaojun AU - Yu X AD - Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China. FAU - Wu, Hua AU - Wu H AD - Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China. FAU - Liu, Lei AU - Liu L AD - Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China. LA - eng PT - Journal Article DEP - 20220922 PL - United States TA - Clin Orthop Relat Res JT - Clinical orthopaedics and related research JID - 0075674 SB - IM CIN - Clin Orthop Relat Res. 2023 Apr 1;481(4):726-727. PMID: 36455100 MH - Male MH - Humans MH - Adult MH - Middle Aged MH - Female MH - Ankle MH - Follow-Up Studies MH - Reinfection/etiology MH - *Diabetes Mellitus, Type 2 MH - *Ilizarov Technique MH - Ankle Joint/diagnostic imaging/surgery MH - *Arthritis, Infectious/diagnostic imaging/surgery/etiology MH - Treatment Outcome MH - Arthrodesis/adverse effects/methods MH - External Fixators MH - Pain/etiology MH - Retrospective Studies PMC - PMC10013661 COIS- Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research(R) editors and board members are on file with the publication and can be viewed on request. EDAT- 2022/09/23 06:00 MHDA- 2023/03/23 06:00 PMCR- 2024/04/01 CRDT- 2022/09/22 10:42 PHST- 2022/03/09 00:00 [received] PHST- 2022/08/30 00:00 [accepted] PHST- 2022/09/23 06:00 [pubmed] PHST- 2023/03/23 06:00 [medline] PHST- 2022/09/22 10:42 [entrez] PHST- 2024/04/01 00:00 [pmc-release] AID - 00003086-202304000-00016 [pii] AID - CORR-D-22-00324 [pii] AID - 10.1097/CORR.0000000000002418 [doi] PST - ppublish SO - Clin Orthop Relat Res. 2023 Apr 1;481(4):717-725. doi: 10.1097/CORR.0000000000002418. Epub 2022 Sep 22.