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Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis
Author(s) -
Hartmann Rebecca,
Grubhofer Florian,
Waibel Felix W. A.,
Götschi Tobias,
Viehöfer Arnd F.,
Wirth Stephan H.
Publication year - 2021
Publication title -
journal of orthopaedic research®
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.24938
Subject(s) - medicine , arthrodesis , surgery , ankle , radiological weapon , external fixator , stage (stratigraphy) , debridement (dental) , paleontology , alternative medicine , pathology , biology
An established treatment strategy in surgical site infection after hindfoot and ankle surgery is a two‐stage procedure with debridement and placement of a cement spacer, followed by antibiotic treatment and secondary arthrodesis. However, there is little evidence to favor this treatment over a one‐stage procedure with debridement, followed by primary arthrodesis with an Ilizarov external fixator and antibiotic treatment. We compared the infection control and clinical and radiological outcome of a two‐stage and a one‐stage procedure. In this study, 7 patients with a two‐stage revision and 11 patients with a one‐stage revision between 2005 and 2015 were included. The primary outcome was infection control (absence of the Musculoskeletal Infection Society PJI criteria) 2 years after the ankle or hindfoot arthrodesis. Secondary outcome measures were the AOFAS hindfoot score and radiological consolidation rate. Infection control was 85% (6 out of 7 patients) in the two‐stage group and 81% (9 out of 11 patients) in the one‐stage group ( p = 1.0). One patient (14%) of the two‐stage and two patients (18%) in the one‐stage group needed below‐knee amputation. In the two‐stage group, the mean postoperative AOFAS score was 74.8 ( SD : ±11.3) versus 71.7 ( SD : ±17.8) in the one‐stage group. Radiological consolidation could be achieved in 71% in the spacer group ( n = 5) and in 72% in the Ilizarov external fixator group ( n = 9). Infection control, AOFAS score, and radiologic consolidation of hindfoot and ankle arthrodesis were comparable in both groups of patients with complicated postsurgical hindfoot or ankle infections.