Staged Joint Arthrodesis in the Treatment of Severe Septic Ankle Arthritis Sequelae: A Case Report

Yong-Cheol Hong, Ki-Jin Jung, Hee-Jun Chang, Eui-Dong Yeo, Hong-Seop Lee, Sung-Hun Won, Jae-Young Ji, Dhong-Won Lee, Ik-Dong Yoo, Sung-Joon Yoon and Woo-Jong Kim
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Yong-Cheol Hong: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea
Ki-Jin Jung: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea
Hee-Jun Chang: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea
Eui-Dong Yeo: Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul 05368, Korea
Hong-Seop Lee: Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea
Sung-Hun Won: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul 04401, Korea
Jae-Young Ji: Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea
Dhong-Won Lee: Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Korea
Ik-Dong Yoo: Department of Nuclear Medicine, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea
Sung-Joon Yoon: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea
Woo-Jong Kim: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan 31151, Korea

IJERPH, 2021, vol. 18, issue 23, 1-9

Abstract: Septic ankle arthritis is a devastating clinical entity with high risks of morbidity and mortality. Prompt treatment is necessary because delayed or inadequate treatment can lead to irreversible damage that may occur on the articular surface, resulting in cartilage erosion, infective synovitis, osteomyelitis, joint deformity, and pain and joint dysfunction. An aggressive surgical approach is required when a joint infection causes severe limb-threatening arthritis. A 58-year-old woman visited our clinic with increasing pain in the right ankle, which had been present for the previous 2 months. She complained of discomfort in daily life due to deformity of the ankle; limping; and severe pain in the ankle even after walking a little. The patient reported a history of right-ankle injury while exiting a bus in her early 20s. Plain radiographs of the right ankle joint revealed that the medial malleolus was nearly absent in the right ankle joint on the anteroposterior view, and severe varus deformity was observed with osteoarthritic changes because of joint space destruction. Magnetic resonance imaging revealed diffuse synovial thickening of the destroyed tibiotalar joint with joint effusion. Hybrid 99mTc white blood cell single-photon emission computed tomography/computed tomography showed increased uptake along the soft tissue around the ankle joint; uptake was generally low in the talocrural and subtalar joints. A two-stage operation was performed to remove the infected lesions and correct the deformity, thus enabling limb salvage. The patient was nearly asymptomatic at the 6-month follow-up, with no discomfort in her daily life and nearly normal ability to carry out full functional activities. She had no complications or recurrent symptoms at the 1-year follow-up. We have described a rare case of a staged limb salvage procedure in a patient with chronic septic arthritis sequelae. For patients with severe joint deformity because of septic ankle sequelae, staged arthrodesis is a reliable method to remove infected lesions, solve soft tissue problems, correct deformities, and maintain leg length.

Keywords: septic arthritis; iliac graft; internal fixation; external fixation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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