Tae-Hoon Kim1, Ho-Seong Lee2, Young-Rak Choi2, Gyeong-Gu Bak3, Sung-Hoo Kim4, Sang-Gon Kim1

1Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan, Republic of Korea
2Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
3Department of Orthopaedic Surgery, Haeundae Paik Hospital, University of Inje, Busan, Republic of Korea
4Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungcheongbuk-do, South Korea

Keywords: Continuous closed irrigation system, infection, intractable septic ankle arthritis.


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.

Citation: Kim TH, Lee HS, Choi YR, Bak GG, Kim SH, Kim SG. Treatment of intractable septic ankle arthritis with a continuous closed irrigation system. Jt Dis Relat Surg 2024;35(1):3-11. doi: 10.52312/jdrs.2023.1224

Ethics Committee Approval

The study protocol was approved by the Asan Medical Center Ethics Committee (date: August 19, 2022 no: 2022-1139). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept: L.H.S.; Design: L.H.S., K.T.H.; Control/supervision: C.Y.R.; Data collection and/or processing, analysis and/or interpretation, writing the article, references and funding: K.T.H.; Literature review: K.T.H., B.G.G., K.S.H.; Critical review, materials: K.T.H., K.S.G.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.