Multimodal diagnosis of periprosthetic joint infection after total ankle arthroplasty.

BACKGROUND

Diagnosing periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA) remains challenging. This study evaluated clinical, laboratory, imaging, microbiological and histopathological parameters in suspected PJI after TAA. We hypothesized that a multimodal approach improves diagnosis.

METHODS

This retrospective study included 57 patients with suspected PJI after TAA and applied European Bone and Joint Infection Society (EBJIS) criteria. Pre- and intraoperative parameters were analyzed using correlation, group comparison and L1-regularized logistic regression.

RESULTS

33 patients were classified as infection unlikely, 5 as likely, and 19 as confirmed. Strong associations with PJI were observed for 99mTc-SPECT/CT (rs = 0.88), synovial neutrophil percentage, blood culture positivity, microbiology, histology, and sonication (all p < .001).

CONCLUSIONS

Clinical signs, synovial fluid analysis, microbiology, histology, sonication, and 99mTc-SPECT/CT showed substantial discriminatory value and support a multimodal diagnostic strategy in suspected ankle PJI.

LEVELS OF EVIDENCE: Level IV.