Patient-Related Risk Factors for Periprosthetic Ankle Joint Infection: An Analysis of 6977 Total Ankle Arthroplasties

J Foot Ankle Surg. 2018 Mar-Apr;57(2):269-272. doi: 10.1053/j.jfas.2017.09.006. Epub 2017 Dec 15.


Periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a devastating complication that often results in explantation to resolve the infection. The purpose of the present investigation was to determine the patient-related risk factors for PJI after TAA. A national insurance database was queried for patients undergoing TAA using the Current Procedural Terminology and International Classification of Diseases, ninth revision, procedure codes from 2005 to 2012. Patients undergoing TAA with concomitant fusion procedures or more complex forefoot procedures were excluded. PJI within 6 months was then assessed using the International Classification of Diseases, ninth revision, codes for diagnosis or treatment of postoperative PJI. Multivariate binomial logistic regression analysis was performed to evaluate the patient-related risk factors for PJI. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each risk factor, with p < .05 considered statistically significant. A total of 6977 patients were included in the present study. Of these 6977 patients, 294 (4%) had a diagnosis of, or had undergone a procedure for, PJI. The independent risk factors for PJI included age <65 years (OR 1.44; p = .036), body mass index <19 kg/m2 (OR 3.35; p = .013), body mass index >30 kg/m2 (OR 1.49; p = .034), tobacco use (OR 1.59; p = .002), diabetes mellitus (OR 1.36; p = .017), inflammatory arthritis (OR 2.38; p < .0001), peripheral vascular disease (OR 1.64; p < .0001), chronic lung disease (OR 1.37; p = .022), and hypothyroidism (OR 1.32; p = .022). The independent patient-related risk factors identified in the present study should help guide physicians and patients considering elective TAA and develop risk stratification algorithms that could decrease the risk of deep, postoperative infection.

Keywords: complication; periprosthetic joint infection; risk factors; total ankle arthroplasty.

MeSH terms

  • Aged
  • Ankle Joint / physiopathology
  • Ankle Joint / surgery*
  • Arthroplasty, Replacement, Ankle / adverse effects*
  • Arthroplasty, Replacement, Ankle / methods
  • Cohort Studies
  • Device Removal
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Osteoarthritis / diagnostic imaging
  • Osteoarthritis / surgery*
  • Prosthesis Failure
  • Prosthesis-Related Infections / diagnosis*
  • Prosthesis-Related Infections / surgery*
  • Reoperation / methods
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome