Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (4): 842-847. doi: 10.19723/j.issn.1671-167X.2026.04.022

Previous Articles     Next Articles

Single-stage arthrodesis for septic arthritis of the ankle and hindfoot

Zhiyu WANG1, Wenjing LI1,2, Baozhou ZHANG1, Ying LI1,*(), Hui DU1, Yan WANG1, Yong WU1   

  1. 1. Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 102208, China
    2. Beijing Institute of Trauma Orthopedics, Beijing 100035, China
  • Received:2025-10-27 Online:2026-08-18 Published:2026-05-22
  • Contact: Ying LI
  • Supported by:
    the Beijing Health Scientific and Technological Achievements and Appropriate Technologies Promotion Project(BHTPP2024038)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To evaluate the clinical outcomes of one-stage debridement, arthrodesis, and Ilizarov external fixation for the treatment of septic arthritis of the ankle and hindfoot. Methods: A retrospective analysis was conducted on 12 patients with septic arthritis of the ankle or hindfoot who underwent one-stage debridement, arthrodesis, and Ilizarov external fixation performed by the same surgeon between April 2015 and June 2023. The study included 8 males and 4 females, with a mean age of (53.6±16.2) years at surgery; all procedures were unilateral. General clinical characteristics, bacterial culture results, and the time to external fixator removal were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) for pain were recorded and compared between the preoperative period and the final follow-up. Patient satisfaction with the surgery and the occurrence of complications were also documented. Results: All patients were followed up for a mean of (51.3±34.0) months postoperatively. Positive bacterial cultures were found in 7 cases. Infection control was achieved in all patients, with a 100% bone fusion rate confirmed by radiographs or CT. The median time to external fixator removal was 16 (12, 24) weeks. Preoperatively, the median VAS score was 7 (5.3, 7.8) points, and the mean AOFAS ankle-hindfoot score was (42.8±10.4) points. At the final follow-up, the median VAS score was 1 (0, 2) point, and the mean AOFAS score was (77.6±10.2) points, both showing significant improvement compared with preoperative values (P < 0.01). Regarding complications, there was 1 case of pin tract infection, 3 cases of limb shortening, and 2 cases of skin numbness. Nine patients were very satisfied with the surgery, and 3 were satisfied. Conclusion: One-stage debridement, arthrodesis, and Ilizarov external fixation are a reliable method for treating septic arthritis of the ankle and hindfoot. It effectively controls infection, shortens treatment duration, and yields favorable functional and imaging outcomes, with high patient satisfaction and acceptable complication rates.

Key words: Septic arthritis, Ankle, Hindfoot, Single-stage procedure, Arthrodesis

CLC Number: 

  • R684.3

Figure 1

A case of ankle arthrodesis infection treated with primary debridement, tibiotalocalcaneal arthrodesis, and Ilizarov external fixation Patient, male, 71 years old, with postoperative infection following left ankle arthrodesis. A and B, weight-bearing anteroposterior and lateral radiographs of the left ankle before the initial ankle arthrodesis demonstrated ankle osteoarthritis, ankle varus, and anterior dislocation of the talus relative to the tibia; C and D, immediate postoperative radiographs after the initial ankle arthrodesis showed fixation of the ankle with three screws; E and F, six months after the initial ankle arthrodesis, weight-bearing anteroposterior and lateral radiographs of the left ankle revealed nonunion, loosening and backing out of the screws, and erosion and destruction of the periarticular bone; G, following removal of the three screws and thorough debridement, one-stage tibiotalocalcaneal arthrodesis with Ilizarov external fixation was performed; H to J, six months postoperatively, radiographs and CT scan indicated bony union."

Table 1

Comparison of AOFAS ankle-hindfoot scores and VAS scores preoperatively and at the final follow-up"

Parameters Preoperative Final follow-up Statistic P value
AOFAS ankle-hindfoot score，$\bar{x} \pm s$ 42.8±10.4 77.6±10.2 t=-6.952 ＜0.001
VAS score，M(P25, P75) 7.0 (5.3, 7.8) 1.0 (0, 2.0) Z=-3.074 0.002

Figure 2

Typical case: Postoperative infection of an ankle fracture treated with removal of internal fixation, one-stage debridement, ankle arthrodesis, and Ilizarov external fixation Patient, male, 77 years old, presented with pain and swelling in the right ankle for over 1 year following an ankle fracture surgery. A and B, preoperative weight-bearing clinical photographs of both ankles showing swelling in the right ankle, with satisfactory hindfoot alignment; C to E, preoperative weight-bearing anteroposterior and lateral radiographs and weight-bearing sagittal CT scan of the right ankle revealed postoperative changes from the internal fixation, demonstrating a moth-eaten appearance of bone destruction in the ankle joint; F, intraoperative view via a lateral approach to the ankle joint, showing accumulation of purulent fluid within the right ankle joint; G and H, the ankle joint internal fixation was removed, and after thorough debridement, primary ankle arthrodesis with Ilizarov external fixation was performed; I and J, immediate postoperative anteroposterior and lateral radiographs of the right ankle; K to O, at the final follow-up, radiographs and CT scans confirmed bony union with satisfactory hindfoot alignment."

1
Simoni G , Maccauro G , Fenga D , et al. Arthrodesis of the ankle joint in septic osteoarthritis: Six years long term outcomes in authors' personal experience[J]. Eur Rev Med Pharmacol Sci, 2019, 23 (Suppl 2): 139- 144.
2
Hong YC , Jung KJ , Chang HJ , et al. Staged joint arthrodesis in the treatment of severe septic ankle arthritis sequelae: A case report[J]. Int J Environ Res Public Health, 2021, 18 (23): 12473.

doi: 10.3390/ijerph182312473
3
Kienast B , Kiene J , Gille J , et al. Posttraumatic severe infection of the ankle joint-long term results of the treatment with resection arthrodesis in 133 cases[J]. Eur J Med Res, 2010, 15 (2): 54.

doi: 10.1186/2047-783X-15-2-54
4
Mankovecky MR , Roukis TS . Arthroscopic synovectomy, irrigation, and debridement for treatment of septic ankle arthrosis: A systematic review and case series[J]. J Foot Ankle Surg, 2014, 53 (5): 615- 619.

doi: 10.1053/j.jfas.2013.10.012
5
Hulscher JBF , te Velde EA , Schuurman AH , et al. Arthrodesis after osteosynthesis and infection of the ankle joint[J]. Injury, 2001, 32 (2): 145- 152.

doi: 10.1016/S0020-1383(00)00156-X
6
Suda AJ , Richter A , Abou-Nouar G , et al. Arthrodesis for septic arthritis of the ankle: Risk factors and complications[J]. Arch Orthop Trauma Surg, 2016, 136 (10): 1343- 1348.

doi: 10.1007/s00402-016-2520-y
7
Pérez-Prieto D , Portillo ME , González-Lucena G , et al. Foot and ankle infections: Debridement, early fixation and rifampicin provide earlier recovery of function and quality of life[J]. Foot Ankle Surg, 2019, 25 (1): 13- 18.

doi: 10.1016/j.fas.2017.07.644
8
Kollig E , Esenwein SA , Muhr G , et al. Fusion of the septic ankle: Experience with 15 cases using hybrid external fixation[J]. J Trauma Inj Infect Crit Care, 2003, 55 (4): 685- 691.

doi: 10.1097/01.TA.0000051933.83342.E4
9
Klouche S , El-Masri F , Graff W , et al. Arthrodesis with internal fixation of the infected ankle[J]. J Foot Ankle Surg, 2011, 50 (1): 25- 30.

doi: 10.1053/j.jfas.2010.10.011
10
Hartmann R , Grubhofer F , Waibel FWA , et al. Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis[J]. J Orthop Res, 2021, 39 (10): 2151- 2158.

doi: 10.1002/jor.24938
11
Richter I , Krähenbühl N , Ruiz R , et al. Mid- to long-term outcome in patients treated with a mini-open sinus-tarsi approach for calcaneal fractures[J]. Arch Orthop Trauma Surg, 2021, 141 (4): 611- 617.

doi: 10.1007/s00402-020-03530-3
12
Movassaghi K , Wakefield C , Bohl DD , et al. Septic arthritis of the native ankle[J]. JBJS Rev, 2019, 7 (3): e6.

doi: 10.2106/JBJS.RVW.18.00080
13
Mercurio M , Castioni D , Porco E , et al. Periprosthetic ankle infection: Eradication rate, complications, and limb salvage. A systematic review[J]. Foot Ankle Surg, 2022, 28 (5): 550- 556.

doi: 10.1016/j.fas.2021.07.009
14
Solow M , Sarraj M , Johal H , et al. A case report of pneumococcal septic arthritis following a respiratory and gastrointestinal prodrome with accompanying literature review[J]. J Foot Ankle Surg, 2019, 58 (6): 1293- 1297.

doi: 10.1053/j.jfas.2018.12.043
15
Gee C , Tandon T , Avasthi A , et al. Primary meningococcal septic arthritis of the ankle joint: A case report[J]. J Foot Ankle Surg, 2014, 53 (2): 216- 218.

doi: 10.1053/j.jfas.2013.12.019
16
Rabinovich RV . Complex ankle arthrodesis: Review of the literature[J]. World J Orthop, 2015, 6 (8): 602.

doi: 10.5312/wjo.v6.i8.602
17
Ellington K , Hirose CB , Bemenderfer TB . What is the treatment "algorithm" for infection after ankle or hindfoot arthrodesis[J]. Foot Ankle Int, 2019, 40 (Suppl 1): 64S- 70S.
18
Perlman MH , Thordarson DB . Ankle fusion in a high risk population: An assessment of nonunion risk factors[J]. Foot Ankle Int, 1999, 20 (8): 491- 496.

doi: 10.1177/107110079902000805
19
Cierny G , Cook WG , Mader JT . Ankle arthrodesis in the presence of continuous sepsis[J]. Clin Podiatric Med Surg, 1990, 7 (3): 545- 563.

doi: 10.1016/S0891-8422(23)00387-7
20
Meyer C , Badillo K , Burns P . Safety and complication rate of ring external fixation in the foot and ankle[J]. J Foot Ankle Surg, 2023, 62 (6): 991- 995.

doi: 10.1053/j.jfas.2023.08.002
[1] Meng FAN, Mengying WANG, Siyue WANG, Hexiang PENG, Xueheng WANG, Huangda GUO, Tianjiao HOU, Xueying QIN, Dafang CHEN, Yonghua HU, Jin LI, Yiqun WU, Tao WU. Association between indicators of arterial stiffness and all-cause mortality and cardiovascular deaths: A prospective cohort study [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1153-1159.
[2] Wenjing LI,Baozhou ZHANG,Heng LI,Liangpeng LAI,Hui DU,Ning SUN,Xiaofeng GONG,Ying LI,Yan WANG,Yong WU. Tibiotalocalcaneal arthrodesis for end-stage ankle and hindfoot arthropathy: Short- and mid-term clinical outcomes [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 299-306.
[3] Shi-kai XIONG,Wei-li SHI,An-hong WANG,Xing XIE,Qin-wei GUO. Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT [J]. Journal of Peking University (Health Sciences), 2023, 55(1): 156-159.
[4] DENG Xue-rong,SUN Xiao-ying,ZHANG Zhuo-li. Agreement between ultrasound-detected inflammation and clinical signs in ankles and feet joints in patients with rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1037-1042.
[5] Cheng WANG,Ling-yu MENG,Na-yun CHEN,Dai LI,Jian-quan WANG,Ying-fang AO. Management algorithm for septic arthritis after anterior cruciate ligament reconstruction [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 850-856.
[6] HOU Zong-chen,AO Ying-fang,HU Yue-lin,JIAO Chen,GUO Qin-wei,HUANG Hong-shi,REN Shuang,ZHANG Si,XIE Xing,CHEN Lin-xin,ZHAO Feng,PI Yan-bin,LI Nan,JIANG Dong. Characteristics and related factors of plantar pressure in the chronic ankle instability individuals [J]. Journal of Peking University (Health Sciences), 2021, 53(2): 279-285.
[7] Dong JIANG,Yue-lin HU,Chen JIAO,Qin-wei GUO,Xing XIE,Lin-xin CHEN,Feng ZHAO,Yan-bin PI. Mid-to-long term outcomes and influence factors of postoperative concurrent chronic ankle instability and posterior ankle impingement [J]. Journal of Peking University(Health Sciences), 2019, 51(3): 505-509.
[8] WANG Rong-li, ZHOU Zhi-hao, XI Yu-cheng, WANG Qi-ning, WANG Ning-hua, HUANG Zhen. Preliminary study of robot-assisted ankle rehabilitation for children with cerebral palsy [J]. Journal of Peking University(Health Sciences), 2018, 50(2): 207-212.
[9] JI Hong-quan, ZHOU Fang, TIAN Yun, ZHANG Zhi-shan, GUO Yan, LV Yang, YANG Zhong-wei, HOU Guo-jin. One of the pitfalls in the surgical treatment of maisonneuve fractures: a case report [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 354-356.
[10] GONG Xiao-feng, LYU Yan-wei, WANG Jin-hui, WANG Yan, WU Yong, WANG Man-yi. A correlation analysis of the ankle CT and ankle fracture classification [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 281-285.
[11] WANG Zi-yun, WU Xin-bao. Anterior dislocation of the fibula resulting from surgical malreduction: a case report [J]. Journal of Peking University(Health Sciences), 2016, 48(2): 361-365.
[12] ZHANG Zi-an, WU Xin-bao, WANG Man-yi. A comparative research on the treatment of ankle fracture with dislocation between emergency surgery and selective surgery [J]. Journal of Peking University(Health Sciences), 2015, 47(5): 791-795.
[13] SUN Ke-Xin, LIU Zhi, CAO Ya-Ying, JUAN Juan, XIANG Xiao, YANG Cheng, HUANG Shao-Ping, LIU Xiao-Fen, LI Na, TANG Xun, LI Jin, WU Tao, CHEN Da-Fang, HU Yong-Hua- . Relationship between brachial-ankle pulse wave velocity and glycemic control of type 2 diabetes mellitus patients in Beijing community population [J]. Journal of Peking University(Health Sciences), 2015, 47(3): 431-436.
[14] GUAN Jing-Lin, JIANG Wen- , WANG Huai-Yu, ZENG Hui, ZHANG Su-Min, WANG Guang, MAO Jie-Ming. Multiple effect of simvastatin on vascular endothelium of hypercholesterolemia patients [J]. Journal of Peking University(Health Sciences), 2014, 46(5): 703-706.
[15] LIU Miao, HE Yao, JIANG Bin, WU Lei, WANG Jian-Hua, YANG Shan-Shan, WANG Yi-Yan, LI Xiao-Ying. Relationship between brachial-ankle pulse wave velocity and metabolic syndrome among the elderly in a Beijing community and the gender difference [J]. Journal of Peking University(Health Sciences), 2014, 46(3): 429-434.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd