Foot and Ankle

Foot & Ankle questions and answers

Foot-and-Ankle-live-1082018

Table of Contents

Prevention

Total Ankle Arthroplasty-Specific

  • Question 1: What are the important risk factors that predispose a patient to infection of total ankle arthroplasty?
  • Question 2: Does intra-articular injection of the ankle with corticosteroids increase the risk of subsequent PJI following TAA? If so, how long after a prior intra-articular injection can TAA be safely performed?
  • Question 3: Should routine MRSA screening be in place prior to total ankle arthroplasty?
  • Question 4: What preoperative optimization should be implemented to reduce the risk of SSI/PJI in patients undergoing total ankle arthroplasty?
  • Question 5: What prophylactic antibiotic (type, dose, and route of administration) should be administered perioperatively for patients undergoing total ankle arthroplasty?
  • Question 6: What is the optimal management of patients with prior septic arthritis of the ankle who are undergoing total ankle arthroplasty?
  • Question 7: During draping for TAA, should the foot be prepped into the surgical field or be covered?
  • Question 8: Should antibiotic-impregnated cement be used during primary total ankle arthroplasty?

Non-Total Ankle Arthroplasty-Specific

  • Question 1: What are the benefits and risks associated with the use of vancomycin powder in the wound during total ankle arthroplasty or other foot and ankle procedures?
  • Question 2: Is there a role for the use of dilute betadine irrigation or other antiseptic irrigation solutions during total ankle arthroplasty or other foot and ankle procedures?
  • Question 3: Does revascularization prior to foot and ankle surgery reduce the incidence of SSI?
  • Question 4: Are prophylactic perioperative antibiotics required for isolated forefoot procedures, such as hammertoes?

Diagnosis

Total Ankle Arthroplasty-Specific

  • Question 1: What is the definition of acute and chronic PJI of total ankle arthroplasty?
  • Question 2: What is the diagnostic “algorithm” for infected total ankle arthroplasty?
  • Question 3: What tests are useful to investigate a possible infection of total ankle arthroplasty? What are their thresholds?
  • Question 4: What are the indications for aspiration of a possibly infected total ankle arthroplasty?
  • Question 5: What is the best technique for performing aspiration of patients with TAA?
  • Question 6: Should aspiration of the ankle with an antibiotic spacer be performed prior to reimplantation?
  • Question 7: Is there a role for measuring synovial biomarkers for diagnosis of infected total ankle arthroplasty?
  • Question 8: What is the role of molecular techniques for detection of pathogen DNA (PCR or Next-generation sequencing) in patients with infected total ankle arthroplasty?
  • Question 9: Should culture samples be taken during all revision total ankle arthroplasty?

Non-Total Ankle Arthroplasty-Specific

  • Question 1: What is the optimal number of samples for culture in patients undergoing surgery for foot and ankle infections?
  • Question 2: What strategies can be implemented to help isolate the causative organism in patients with infection of the foot and ankle?
  • Question 3: What is the optimal method to perform bone biopsy (method, location, imaging use) for patients with foot and ankle infections?
  • Question 4: What is the best method to differentiate acute Charcot foot from acute infection?

Treatment

Total Ankle Arthroplasty-Specific

  • Question 1: What is the treatment “algorithm” for an infected total ankle arthroplasty?
  • Question 2: What is the optimal (type, dose, and route of administration) antibiotic treatment for patients with infected total ankle arthroplasty?
  • Question 3: Is there a role for suppressive antibiotics in patients with PJI of total ankle arthroplasty who have undergone surgical treatment?
  • Question 4: What determines the type and dose of antibiotic that is needed to be added to the cement spacer in patients with infected total ankle arthroplasty?
  • Question 5: What are the indications and contraindications for DAIR (I and D and retention of prosthesis) in patients with infected total ankle arthroplasty?
  • Question 6: What is the optimal protocol for performing DAIR in an infected TAA? (type and volume of irrigation solution, and so on)
  • Question 7: What are the indications for one-stage versus two-stage exchange arthroplasty in management of the infected total ankle arthroplasty?
  • Question 8: What metrics can be used to determine the optimal timing of reimplantation in patients who have undergone resection arthroplasty as part of a two-stage exchange for infected total ankle arthroplasty?
  • Question 9: What are the predictors of treatment failure in patients who have undergone two-stage exchange for infected total ankle arthroplasty?
  • Question 10: How should postoperative cellulitis be treated in patients with total ankle arthroplasty in place?
  • Question 11: Does deep chronic infection after total ankle arthroplasty require implant removal?

Non-Total Ankle Arthroplasty-Specific

  • Question 1: What is the treatment “algorithm” for infection after ankle or hindfoot arthrodesis?
  • Question 2: What is the optimal antibiotic (type, dose, and route of administration) treatment for infections after foot/ankle fracture or fusion procedures?
  • Question 3: What is the treatment “algorithm” for infection after Achilles tendon repair/reconstruction?
  • Question 4: Should treatment of diabetic foot osteomyelitis be based on bone biopsies?