Infections in primary total ankle replacement: Anterior approach versus lateral transfibular approach

Usuelli, Federico Giuseppe; Indino, Cristian; Maccario, Camilla; Manzi, Luigi; Liuni, Federico Maria; Vulcano, Ettore

doi:10.1016/j.fas.2017.07.643

Cited by 35 publications

(23 citation statements)

References 39 publications

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“…General procedures associated with orthopaedics diagnosis and treatment, musculoskeletal device removal and musculoskeletal device implantation had the highest prevalence within the sample, while general procedures associated with orthopaedic diagnosis and treatment, hip replacement revision and knee replacement revision had the highest numbers in absolute terms. This is consistent with studies reporting prosthetic joint infection as a recurrent complication of joint replacement procedures, which may reach up to 20% in cases of revision [38,39]. The rate is roughly confirmed by this research, as knee and hip replacement revisions were associated with an infection in 16.50 and 24.49% of patients, respectively.…”

Section: Discussionsupporting

confidence: 92%

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Pirisi¹,

Pennestrì

Viganò

et al. 2020

BMC Infect Dis

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Background: Healthcare-associated infections (HAIs) represent a serious burden to individual safety and healthcare sustainability. Identifying which patients, procedures and settings are most at risk would offer a significant contribution to HAI management and prevention. The purpose of this study is to estimate 1) orthopaedic implantable device-related infection (OIDRI) prevalence in Italian hospitals and 2) the gap between the remuneration paid by the Italian healthcare system and the real costs sustained by Italian hospitals to treat these episodes. Methods: This is a cross-sectional study based on hospital discharge forms registered in 2012 and 2014. To address the first goal of this study, the national database was investigated to identify 1) surgical procedures associated with orthopaedic device implantation and 2) among them, which patient characteristics (age, sex), type of admission, and type of discharge were associated with a primary diagnosis of infection. To address the second goal, 1) each episode of infection was multiplied by the remuneration paid by the Italian healthcare system to the hospitals, based on the diagnosis-related group (DRG) system, and 2) the total days of hospitalization required to treat the same episodes were multiplied by the average daily cost of hospitalization, according to estimates from the Ministry of the Economy and Finance (MEF). Results: In 2014, 1.55% of the total hospitalizations for orthopaedic device implantation procedures were associated with a main diagnosis of infection, with a negligible increase of 0.04% compared with 2012. Hip and knee replacement revisions, male patients and patients older than 65 years were more exposed to infection. A total of 51.63% of patients were planned admissions to the hospital, 68.75% had an ordinary discharge to home, and 0.9% died. The remuneration paid by the healthcare system to the hospitals was € 37,519,084 in 2014, with 3 DRGs covering 70.6% of the total. The cost of the actual days of hospitalization to treat these episodes was 17.5 million more than the remuneration received. Conclusions: The OIDRI prevalence was lower than that described in recent surveys in acute care settings, although the numbers were likely underestimated. The cost of treatment varied significantly depending on the remuneration system adopted.

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Section: Discussionsupporting

confidence: 92%

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Pirisi¹,

Pennestrì

Viganò

et al. 2020

BMC Infect Dis

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“…39,44 This novel approach has been shown to be safe and effective at short-term follow-up, yet midterm results have not yet been published. 11,39,43 The purpose of this study was to prospectively evaluate clinical and radiographic findings in a transfibular total ankle replacement with a minimum of 2 years' follow-up.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty

et al. 2018

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“…Although there has been a recent study that evaluates the lateral approach for TAA with equivalent results to the anterior approach, there has been no published outcome data regarding the anteromedial approach for TAA. 21…”

Section: Discussionmentioning

confidence: 99%

Effect of Novel Anteromedial Approach on Wound Complications Following Ankle Arthroplasty

2020

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Background: The purpose of this study was to evaluate all wound complications following total ankle arthroplasty (TAA) before and after the implementation of a novel extensile anteromedial surgical approach. We further investigated patients and operative factors associated with wound complications. Methods: A series of 660 TAAs were collected. The median follow-up was 84 months (range, 12-204 months). Minor wound complications included discoloration, swelling, or clinical concern that merited bringing the patient back sooner for review. Major wound complications included plastic surgical consultation, debridement by the nurse specialist, negative pressure therapy, or reoperation. All major complications initially had a course of empirical oral antibiotics. Since 2011, higher-risk patients have had their TAA performed through an extensile anteromedial approach. Results: Fifty-six patients (8.5%) had wound healing issues (17 major [2.6%], 39 minor [5.9%]). All issues became evident <21 days postoperatively. Inflammatory arthritis, smoking, and coronary disease were patient factors associated with major wound complications. Four patients were treated with negative pressure therapy, 4 with debridement in the operating room, and 2 eventually converted to fusions. Fourteen patients (82%) who had major complications had an ancillary procedure to balance the TAA through a separate incision. All major wound complications had an anterior surgical approach for their TAA. Before 2011, there were 13 major wound complications. Since 2012, there have been 4 major wound complications overall, with no wound complications in the anteromedial approach cohort. Conclusion: We recommend an extensile anteromedial approach for smokers and patients with heart disease or inflammatory arthritis undergoing TAA. If a wound complication developed, a multidisciplinary team to evaluate wounds was useful. Level of Evidence: Level III, retrospective comparative series.

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Infections in primary total ankle replacement: Anterior approach versus lateral transfibular approach

Cited by 35 publications

References 39 publications

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Prevalence and burden of orthopaedic implantable-device infections in Italy: a hospital-based national study

Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty

Effect of Novel Anteromedial Approach on Wound Complications Following Ankle Arthroplasty

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