Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery?

Background: Previous studies about antibiotic prophylaxis in foot and ankle surgery have focused on perioperative intravenous administration, with few studies reporting on the efficiency of postoperative oral antibiotics. The purpose of this study is to investigate differences in the rate of postoperative infection and wound complications between patients with and without postoperative oral antibiotics and to identify independent risk factors for these complications following foot and ankle surgeries. Methods: A retrospective review of all elective foot and ankle surgeries with at least a 6-month follow-up was performed over a 2-year time span. Patients were divided into 2 groups based on if they received postoperative oral antibiotics. We compared the rates of postoperative infections and wound complications between the 2 groups. The surgical site, the number of Current Procedural Terminology codes, and the number of surgical incisions were also noted. Multivariable logistic regression analysis was performed to identify independent risk factors of postoperative infection and wound complications. Results: A total of 366 patients were included in this study-240 with antibiotics and 126 without antibiotics. There was no significant difference in the rates of postoperative infection and wound complications between the 2 groups. The rate of superficial infection, deep infection, and wound complications was 1.7%, 0.8%, and 5.8% in the antibiotic group vs 3.2%, 0.0%, and 4.0% in patients without antibiotics, respectively. Multivariable logistic regression analysis identified independent risk factors of postoperative infection and wound complications as follows: smoking (OR: 4.7), male (OR: 4.0), history of neoplasm (OR: 6.7), and multiple incisions (OR: 4.1). Conclusion: Our results suggest that routine postoperative prophylactic oral antibiotics are not needed following elective foot and ankle surgeries. However, certain risk factors may increase the risk for postoperative infection and wound complications in foot and ankle surgery. Level of Evidence: Level III, case-control study.

The efficacy and safety of tranexamic acid utilization in total ankle arthroplasty: a systematic review and meta-analysis.

INTRODUCTION: There is still a lack of information on the role of Tranexamic acid (TXA) in total ankle arthroplasty (TAA). The purpose of this study is to comprehensively review, consolidate, and analyze findings from existing research on the effectiveness and safety of TXA in TAA. MATERIALS AND METHODS: The comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, Web of Science, and Cochrane databases, for original, English-language studies investigating the efficacy and safety of TXA in TAA, through February 2023. Evaluated data for the meta-analysis included estimated blood loss (EBL), change in perioperative hemoglobin, need for transfusion, and complications including DVT/PE, and wound complications. RESULTS: A total of nine studies were included in this study. In total, 450 TAA were included, with 244 receiving TXA (54.2%) and 206 not receiving TXA (45.8%). TXA in TAA significantly decreased EBL. A significantly lower rate of wound complications in the TXA group with the relative risk (RR) of 0.51. We classified wound complications into wound infection and delayed wound healing/dehiscence. A significant decrease in the rate of wound infection and a tendency showing a decrease in the rate of delayed wound healing/dehiscence in the TXA group were noted: the RR of 0.29, and 0.63, respectively. TXA did not increase the incidence of DVT/PE following TAA. CONCLUSIONS: In conclusion, the utilization of TXA during TAA demonstrated a statistically significant reduction in EBL and relative risk for wound complications. However, further RCTs with larger sample sizes will be necessary to establish a more robust conclusion regarding the efficacy and safety of TXA in TAA. LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis.

No Difference in Range of Motion, Components, or Complications Following Conversion of Robotic-Assisted Total Knee Arthroplasty Compared to Manual TKA After Undergoing Manual or Robotic-Assisted Unicompartmental Knee Arthroplasty.

Background: Conversion surgery from unicondylar knee arthroplasty (UKA) to total knee arthroplasty (TKA) remains a challenge due to scarring, implant/cement removal, and loss of bony landmarks. Robotic-assisted (RA) TKA may assist in challenges seen in manual conversion TKA. The aim of this study is to identify if there are differences in components and functional outcomes dependent on manual/RA primary UKA and conversion TKA. Methods: A retrospective chart review was performed on patients undergoing conversion from UKA to TKA over a 10-year period at a single institution. Data extracted included surgical technique, reason for UKA failure, range of motion at 1 year, need for augments, and utilization of revision components. Results: Forty-nine patients (50 knees) with a UKA converted to a TKA were divided into 4 groups based on primary and conversion surgery: manual-to-manual (n = 11), manual-to-robot (n = 11), robot-to-manual (n = 11), and robot-to-robot (n = 17). There was no difference in need for augments (P = .376), size of poly (P = .23), postoperative flexion (P = .52), or extension (P = .76) at 1 year between the 4 groups. However, patients with primary manual UKA did require significantly more augments during revision (P = .032). Conclusions: Our study did not show any statistically significant differences of primary RA or manual UKA to RA or manual TKA in terms of range of motion at 1 year, complications, or differences in components. RA conversion from UKA to TKA is a new but equivalent technique to manual conversion. Primary surgery may impact the requirement for augments during conversion surgery.

Suture button fixation yields high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries: A systematic review.

IMPORTANCE: Lisfranc injuries remain a significant, but often misdiagnosed, orthopaedic injury. Alongside the traditional methods of surgical fixation, including arthrodesis and open reduction and internal fixation with screws, suture button fixation is an emerging technique. OBJECTIVES: The purpose of this study is to investigate the efficacy of suture button fixation for treatment of Lisfranc injuries through a systematic review. EVIDENCE REVIEW: A comprehensive literature review was conducted according to the preferred reporting items for systematic reviews using PubMed, Embase, Web of Science, and Cochrane databases for original, English-language studies observing outcomes of Lisfranc injury until August 19, 2022. The clinical studies with evidence level I-IV and at least a 12 month follow-up after the index surgery were included if they examined quantifiable outcomes of Lisfranc injury treated with suture button. Articles were excluded if they included case reports, systematic reviews, comments, editorials, surveys, animal studies, or biomechanical/cadaveric studies. Variables extracted from text and figures include demographic information, return to sport measures, patient reported outcomes, and complications. FINDINGS: Of the 10 studies included, there were 186 total patients with an age range of 13-72. In every study, all patients were able to return to sport or activity with a return time averaging from 10.8 to 25.9 weeks. Postoperative American Orthopaedic Foot and Ankle Society scores ranged from 83.5 to 97.0 while pain Visual Analogue Scale ranged from 0.6 to 2.5. Complications were reported in four studies at a rate of 7.7% including two cases of diastasis, two cases of paraesthesia, one case of button irritation, and one of postoperative degenerative joint disease, with no reported revisions. CONCLUSIONS AND RELEVANCE: In our systematic review, suture button fixation shows high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries. This surgical technique provides a physiologic reduction across the Lisfranc joint and reduces the need for reoperation including removal of hardware. However, further evidence such as large sample size high-quality randomized controlled trials is needed to draw a definitive conclusion regarding the best treatment for Lisfranc injuries. LEVEL OF EVIDENCE: Level IV, Systematic Review of Level III and IV studies.

Utilization of a Revision Acetabular Shell as a Tibial Cone in a Revision Total Knee Arthroplasty Setting.

One of the biggest challenges of a revision total knee arthroplasty is how to obtain adequate tibial metaphyseal fixation in the setting of significant bone loss. There are multiple implants, including stems, metaphyseal cones, and metaphyseal sleeves, that help provide increased fixation and stability. This report demonstrates a case in which a porous tantalum metal revision acetabular shell was used as a large tibial cone, as none of the above options were viable due to the size and position of the tibial defect.

Risk of Malignant Transformation of Giant Cell Tumors of Bone Is 8 Times Lower with Megavoltage vs. Orthovoltage Radiation Therapy.

Background: The first-line treatment for most giant cell tumors (GCTs) of bone is surgical; radiotherapy (RT) is reserved for inoperable or refractory cases. While RT techniques have undergone a dramatic change over the past few decades, with the higher energy megavoltage RT replacing orthovoltage RT, concerns for high rates of malignant transformation following RT have limited its use. Evidence suggests a lower incidence of secondary malignancy after treatment with megavoltage compared with orthovoltage RT, but this has not been studied in GCTs. Our main purpose was to compare the incidence of malignant transformation of GCTB between patients treated with orthovoltage vs. megavoltage RT. Methods: A literature review was performed to identify studies reporting GCTBs treated with RT from 01/1900 through 12/2019. Studies that did not report RT modality or separate orthovoltage and megavoltage results were excluded. Included in the analysis were 6 patients from our institution. Primary outcome was the incidence of malignant transformation; secondary outcomes were time to transformation and incidence of local recurrence. Fisher's exact tests and independent sample t-tests were used, and significance was set at p < 0.05. Results: Twenty-two studies were included, which reported on 168 GCTBs treated with orthovoltage and 393 treated with megavoltage RT. Transformation incidence was 14% (n = 24) for orthovoltage and 1.8% (n = 7) for megavoltage RT, an 8-fold difference (odds ratio (OR) 9.1, 95% confidence interval (CI) 3.9-22, p < 0.001). Mean time to transformation was 8.7 years for orthovoltage and 11.2 years for megavoltage RT (p=0.28). Incidence of local recurrence was 38% (63/167) for orthovoltage and 17% (66/393) for megavoltage RT (OR 3.3, 95% CI 2.0-4.6, p < 0.001). Conclusions: The risk of developing a malignancy after RT of GCTB is 8 times lower with megavoltage than with orthovoltage. Malignant transformation with megavoltage, while not zero, is lower than that in historical series. Use of modern RT techniques in inoperable or refractory GCTB may be appropriate.