Periprosthetic joint infection in total ankle replacement: which are the current diagnostic criteria?

Q2 Medicine

Acta Biomedica de l''Ateneo Parmense Pub Date : 2023-08-03 DOI:10.23750/abm.v94i4.14082

Antonio Izzo, Donato Di Gennaro, Arianna Sgadari, Antonio Coviello, Domenico Marasco, Giovanni Balato, Massimo Mariconda, Alessio Bernasconi

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Abstract

Background and aim: Periprosthetic joint infection (PJI) is among the most common complications of Total Ankle Replacement (TAR) and its management may be challenging. We set out to define which are the criteria currently used to diagnose PJI after TAR.

Methods: This PRISMA-compliant systematic review was registered in the Open Science Framework. Multiple databases were searched including clinical studies in which PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design and the diagnostic criteria for PJI. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS).

Results: Six papers (122 infected TARs) published between 2012 and 2022 were included in this review. Ankle pain with swelling and unexplained increased local temperature were the most common clinical findings leading to a suspicion of PJI. In 100% of cases the diagnosis was confirmed through synovial fluid analysis associated with positive blood tests. In all the revision surgeries intraoperative cultures (at least 3) were performed. In 109 ankles (90%) there was a microbiological isolation. Out of these, 38 (35%) were single organism infections by Staphylococcus coagulase negative and 37 (34%) were single organism infections by Staphylococcus Aureus. The mean mCMS was 37.6 out of 100.

Conclusions: There is a lack of diagnostic criteria specific for PJI after TAR. Clinical and laboratory tests inspired to the knowledge in total knee and total hip arthroplasty are generally adopted in the field of ankle arthroplasty. The quality of evidence for studies included in this review was poor.

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全踝关节置换术中假体周围关节感染:目前的诊断标准是什么?

背景与目的:假体周围关节感染(PJI)是全踝关节置换术(TAR)最常见的并发症之一，其处理可能具有挑战性。我们着手确定哪些是目前用于诊断TAR后PJI的标准。方法:本系统评价符合prisma标准，已在开放科学框架中注册。我们检索了多个数据库，包括诊断和治疗TAR后PJI的临床研究。收集有关队列、研究设计和PJI诊断标准的数据。采用改良的Coleman方法学评分(mCMS)评估偏倚风险。结果:本综述纳入2012 - 2022年间发表的6篇论文(122篇感染TARs)。踝关节疼痛伴肿胀和不明原因的局部温度升高是最常见的临床表现，导致怀疑PJI。在100%的病例中，通过与阳性血液检查相关的滑液分析确诊。所有翻修手术均进行术中培养(至少3次)。109例(90%)踝关节有微生物分离。其中凝固酶阴性葡萄球菌单菌感染38例(35%)，金黄色葡萄球菌单菌感染37例(34%)。平均mCMS为37.6(满分100分)。结论:缺乏针对TAR后PJI的诊断标准。受全膝关节和全髋关节置换术知识启发，在踝关节置换术领域普遍采用临床和实验室检查方法。本综述纳入的研究证据质量较差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Biomedica de l''Ateneo Parmense Medicine-Medicine (all)

CiteScore

4.30

自引率

0.00%

发文量

期刊介绍： Acta Bio Medica Atenei Parmensis is the official Journal of the Society of Medicine and Natural Sciences of Parma, and it is one of the few Italian Journals to be included in many excellent scientific data banks (i.e. MEDLINE). Acta Bio Medica was founded in 1887 and its founders and collaborators, Clinicians and Surgeons, entered history. Acta Bio Medica Atenei Parmensis publishes Original Articles, Commentaries, Review Articles, Case Reports of experimental and general Medicine. A section is devoted to a Continuous Medical Education programme in order to help primary care Physicians to improve the quality of care.