Authors: Nima Heidari, Irvin Oh, Francesc Malagelada
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 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 two 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 surgical 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)FA-13