Frequently Asked Questions

I had an ankle joint replacement two weeks ago. I've been instructed in what to watch for should an infection start to develop. If I'm careful to follow all the instructions, why would I get an infection and if it did, what's the treatment for it?

Surgeons know that replacing the ankle joint (a procedure called total ankle arthroplasty or TAA) is more successful for some patients than for others. This particular operation requires selecting patients carefully for the best outcomes. There are all kinds of potential reasons why one patient might develop complications (such as infection) while others do not. Factors such as age, sex (male versus female), body-mass index (BMI), and general health may make a difference. Some studies show results are compromised most often when the patient has rheumatoid arthritis. In a recent study from Thomas Jefferson University Hospital in Philadelphia, the orthopedic surgeons were interested in narrowing down risk factors associated with complications following total ankle arthroplasty. They specifically focused just on wound infection of the incision used to open the ankle up. By doing a retrospective (looking back) chart review of 106 patients, they were able to see who had problems and why. This information might help you understand your own situation. The authors collected, compared, and analyzed data recorded in their patients' charts. For example, they looked at implant size, the use of medications, smoking (tobacco use) status, and type of sutures used to close the wound. They also separated the patients into three basic groups based on severity of complications. They compared the presence of each of these factors based on which group the patients were in. The first group had no wound complications or only mild/minor problems with the healing incision. Group two had minor complications that could be easily treated with local care and possibly some oral (taken by mouth, usually in pill form) antibiotics. The most difficult and severe group (group number three) had major complications that meant having another operation. The second procedure could be as simple as returning to the operating room and cleaning the joint out, a procedure referred to as irrigation and debridement. More complex operations might include removing the implant or even amputation (removing the foot). As it turns out, the main difference between the groups with no complications or only mild complications and the group with major complications was the presence of diabetes mellitus. The biggest threat to healing without complications was the presence of rheumatoid arthritis (RA). In fact, patients with RA were 14 times more ikely to develop severe enough complications at the incision site to require another operation. Why is rheumatoid arthritis such a big problem? It is an inflammatory condition that is often treated with medications that suppress (decrease) the immune system's response. So any bacteria present at the surgical site aren't always taken care of by the immune system. They can quickly mount an attack on the body. With limited immune capability, the body can't fend off the growing bacteria and a full-blown infection breaks out.

Steven M. Raikin, MD, et al. Risk Factors for Incision-Healing Complications Following Total Ankle Arthroplasty. In The Journal of Bone and Joint Surgery. September 15, 2010. Vol. 92-A. No. 12. Pp. 2150-2155.

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