4.1 of 21 Ratings
A 66-year-old patient with diabetes underwent a left total ankle arthroplasty 2 years ago. The patient has developed left ankle erythema, swelling, and pain over the last 5 weeks. His radiographs are shown in Figures A and B, while a joint aspiration reveals 70K WBCs with gram-positive cocci in clusters. What is the most appropriate treatment and the expected outcome?
IV antibiotics; prosthesis retention
Irrigation and debridement with polyethylene exchange; prosthesis retention
Antibiotic spacer; successful re-implantation of arthroplasty components
Amputation; successful infection eradication
Antibiotic spacer; unlikely for reimplantation of prosthesis
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A 56-year-old patient presents with 3 months of right ankle pain. The patient underwent a total ankle arthroplasty 6 years ago and has remained relatively painless since the procedure. The patient denies any fevers or chills. Serum ESR and CRP are 19 mm/hr and 1.1 mg/L, respectively. Complete blood count revealed a white blood cell count of 9K cells/mL. Physical examination of the surgical wound reveals a well-healed incision and no evidence of drainage or sinus tracts. Synovial fluid analysis from the ankle consisted of 900 nucleated cells/mL, 44% neutrophils, negative gram stain, and no growth on cultures. Figures A and B are AP and lateral radiographs of the right ankle. What is the most appropriate next step?
CT with metal artifact-reducing protocol
A 67-year-old patient presents with a several year history of chronic right medial ankle pain that has failed conservative treatment. Despite the use of orthotics and Arizona bracing, the patient's foot has become flatter over time. There is tenderness along the joint line and pain with passive dorsiflexion and plantarflexion of the tibiotalar joint. Weakness and pain are appreciated with resisted foot inversion. The patient has a rigid hindfoot and is unable to perform a single heel raise. Figures A, B, and C are current radiographs. What is the most appropriate treatment?
Medial slide calcaneal osteotomy, FDL transfer to the navicular, lateral column lengthening, cotton osteotomy, calcaneonavicular ligament reconstruction with peroneus longus tendon, deltoid ligament reconstruction
Total ankle arthroplasty
Triple arthrodesis with deltoid ligament reconstruction