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ISOC

I.S.O.C. meeting

I.S.O.C. – International Society of Orthopaedic Centers
Londra, 13 Maggio 2016
venerdì ore 14:30 – 14:40

La “International Society of Orthopaedic Centers” è una delle più importanti associazioni a livello mondiale. Riunisce a se i maggiori ospedali che si occupano di ortopedia, tra di loro ci sono: Hospital for Special Surgery di New York, la Mayo Clinic di Minnesota e tra di essi anche l’ospedale Galeazzi di Milano.

Sono felice di essere stato chiamato a parlare, il tema che affronterò è fondamentale: le infezioni nelle protesi di caviglia. È un tema importante che può, talvolta, spaventare i pazienti visto che è la maggior complicanza che si può avere. Si fa di tutto per evitarle, abbiamo misure nuove e moderne e riusciamo a tenere una soglia al di sotto del 2%, un risultato eccezionale. Per essere all’avanguardia abbiamo anche pensato allo sviluppo di una serie di strategie terapeutiche per risolvere eventuali problematiche di tipo infettivo.


Revision rate of septic Total Ankle Replacement: a retrospective analysis on 146 cases

F.G. Usuelli*,
U. Alfieri Montrasio*,
C. Maccario*,
L. Manzi*,
A. Pantalone**.
*Foot and Ankle Unit , IRCCS Galeazzi, Milan, Italy
**Orthopaedic and Traumatology Division, Department of Medicine and Science of Aging, University G. d’Annunzio, Chieti-Pescara, Chieti, Italy

INTRODUCTION

Septic loosening of total ankle replacement (TAR) is a serious condition that affects not only the osseous but also the soft tissue parts. Glazebrook et al in 2009 performed a systematic literature review and classified complications related to ankle arthroplasty: the authors found ankle arthroplasty infection to be a high-grade complication due to failure of the implant in 80% of cases. The after-infectionrevision rate reported in the literature is around 3% (Patton D et al. 2015). The purpose of this study was to report our experience about the revision rate of septic TAR.

MATERIALS AND METHODS

A retrospective study was performed of 146 patients with symptomatic end-stage ankle arthritis who underwent total ankle arthroplasty from May 2011 to September 2015. Eighty patients were treated with Hintegra® prosthesis utilizing an anterior surgical approach and tourniquet. The Zimmer® Trabecular Metal™ TAR System was implanted in sixty-six patients by a lateral (side) approach without the use of tourniquet. Patients were evaluated preoperatively and postoperatively with the following clinical methods: pain and function was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Visual Analogue Scale (VAS) pain score, and the 12-Item Short Form Health Survey (SF-12) – physical component summary (PCS) and mental component summary (MCS). Radiographic assessment included weight-bearing radiographs of the ankle [anteroposterior (AP), oblique, lateral, and hindfoot alignment views] preoperatively and postoperatively.

RESULTS

Three patients (all treated with Hintegra® prosthesis and without comorbidities-Charlson Score 0 ) were diagnosed with an infected total ankle arthroplasty. One chronic infection led to a successful revision consisting in the change of the tibial component and the polyethylene inlay. Two patients required a revision arthrodesis using a trabecular metal cage. The our revision rate was 2.0%, measurably less than the corresponding average from literature. This result should be checked as long as a greater number of patients will be added and follow-up extended to a longer observation time.

DISCUSSION AND CONCLUSIONS

Total ankle arthroplasty has been used with increasing frequency, so the risk of infection raised as well. Infections are classified as acute postoperative, late chronic, or remote hematogenous (Myerson MS et al. 2014). Certainly comorbidities such as rheumatoid arthritis, corticosteroid use, diabetes mellitus, obesity, smoking, and malignant tumors are preoperative risk factors for prosthetic infections. The question of why there is a higher incidence of infection in total ankle replacements compared to the hip and knee literature is a difficult one to answer based entirely on evidence. Therefore the revision of septic TAR have a significant relevance on social medical costs: the costs of ankle revision surgeries were estimated from Medicare 2007 payment schedules around $ 16,000 (Courville XF et al. 2011).