Unsuspected low-grade infection in revision surgery for nonunion in foot and ankle arthrodesis

Low-grade infection should be considered as a possible explanation of a nonunion, despite the lack of local inflammatory signs. As 22% of the nonunions were unexpectedly caused by low-grade infection, we strongly recommend obtaining at least five tissue samples for culture during revision arthrodesis. The success rate of revision surgery followed by targeted antibiotics in patients with a low-grade infection is 77%, which is lower than the outcome in revision surgery for patients without infection (88%), although not significant (p = 0.451).