Treatment of intractable septic ankle arthritis with a continuous closed irrigation system

Objectives: The study aimed to evaluate the efficacy of a continuous closed irrigation system (CCIS) after open debridement for patients with intractable septic ankle arthritis.Patients and methods: The retrospective study analyzed the intractable septic arthritis of 12 (6 males, 6 females; mean age: 64.1 +/- 14.7 years; range, 33 to 80 years) patients managed by CCIS between July 2015 and July 2020. All patients had previously undergone operations to treat septic ankle arthritis without resolution of the infection. After open debridement, the CCIS was usually equipped with two outflow tubes and one inflow tube. Saline inflow was about 1 L per day.Results: The mean follow-up period was 30.8 +/- 14.9 (range, 15 to 70) months. The CCIS was maintained for a mean of 5.1 +/- 2.1 (range, 3 to 7) days. The mean number of operations the patients had previously undergone was 2.83 +/- 1.5 (range, 1 to 6). For 11 (91.6%) out of 12 patients, infection did not recur after one-time CCIS, and laboratory test results remained normal. Six patients had previously undergone total ankle replacement arthroplasty. These patients underwent antibiotics-mixed cement arthroplasty after CCIS. For five of six with infected total ankle replacement arthroplasty, infection did not recur after CCIS. However, one patient without the removal of both implants experienced recurrence at the same site after four postoperative months. In the reoperation, after the removal of both implants and the application of antibiotics-mixed cement arthroplasty, the infection was cleared.Conclusion: Use of CCIS after open debridement for intractable septic ankle arthritis is a good treatment option since it is relatively simple and safe, with good results.