Extended Oral Antibiotic Prophylaxis After Aseptic Total Hip or Knee Arthroplasty Revisions: A Preliminary Report.

BACKGROUND: It is unknown whether extended oral antibiotic (EOA) prophylaxis reduces periprosthetic joint infection (PJI) rates after aseptic revision total hip (THA) and knee arthroplasty (TKA). The literature is scarce. Therefore, we sought to ascertain whether EOA prophylaxis decreases PJI rates after aseptic first-time revision THA and TKA when compared to standard prophylaxis. METHODS: This is a retrospective review of 328 consecutive revisions (3 surgeons, single institution, from September 27, 2017 to December 31, 2019). Preoperative 2013 Musculoskeletal Infection Society (MSIS) criteria, radiographs, and medications were reviewed. Inclusion criteria included aseptic first-time revision THA and TKA. Exclusion criteria were positive intraoperative cultures and/or histology, PJI (2013 MSIS criteria), hemiarthroplasty/partial arthroplasty revision, revision using foreign material (ie, mesh), metastatic bone disease, and intravenous antibiotics >24 hours after surgery. A total of 178 revisions were included, and 2 groups were set apart based on antibiotic prophylactic regime. The following were the groups: (1) EOA prophylaxis (>24 hours, n = 93) and (2) standard prophylaxis (≤24 hours, n = 85). Demographics, joint types, lengths of stay, skin-to-skin operative times, revision types, transfusions, discharge dispositions, and PJIs (per 2013 MSIS criteria) after the first-time revision were compared between groups. There were no significant differences in demographics. However, skin-to-skin operative time was significantly higher in the EOA group (123 minutes versus 98 minutes, P = .01). Mean follow-up was 849 days (range, 15-1,671). Statistical significance was set at a P value lower than .05. RESULTS: Postoperative PJI rates were not significantly different: 2.2% EOA prophylaxis versus 3.5% standard prophylaxis (P = .671). CONCLUSION: No significant difference was found between PJI rates between both prophylactic regimens. A large multicenter study with a larger sample size is needed to support EOA after aseptic revisions. LEVEL OF EVIDENCE: Level III.

Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures.

BACKGROUND: The plantar fascia attaches to the tuberosity of the calcaneus, which produces a distinct plantar medial avulsion (PMA) fracture fragment in certain calcaneal fractures. We hypothesized that tongue-type fractures, as described by the Essex-Lopresti classification, were more likely to be associated with this PMA fracture than joint depression fractures. METHODS: A retrospective chart review was performed at 2 distinct Level I trauma centers to identify patients sustaining calcaneal fractures. Radiographs were then reviewed to determine the Essex-Lopresti classification, OTA classification, and presence of a PMA fracture. RESULTS: The review yielded 271 total patients with 121 (44.6%) tongue-type (TT), 110 (40.6%) joint depression (JD), and 40 (14.8%) fractures not classifiable by the Essex-Lopresti classification. In the TT group, 73.6% of the patients had the PMA fracture whereas only 8.2% of JD and 15.0% of nonclassifiable fractures demonstrated a PMA fragment ( P < .001). CONCLUSION: Plantar medial avulsion fractures occurred in 38.4% of the calcaneal fractures reviewed with a significantly greater proportion occurring in TT (73.6%) as opposed to JD (8.2%). Given the plantar fascia attachment to the PMA fragment, there may be clinical significance to identifying this fracture and changing treatment management; however, this requires further investigation. LEVEL OF EVIDENCE: Level III, comparative study.

Complications After Popliteal Block for Foot and Ankle Surgery.

BACKGROUND: A popliteal nerve block is a common analgesic procedure for patients undergoing surgery on their knee, foot, or ankle. This procedure carries less risk in a surgical setting compared with other forms of anesthesia such as a spinal block. Previous reports demonstrated few to no complications with the use of this nerve block, but it is unclear whether these data are consistent with the recent increase in use of this analgesic procedure for lower extremity surgery. METHODS: Retrospectively, a busy orthopedic foot and ankle practice performed a chart review examining for postoperative neuropathic complications possibly related to the popliteal nerve block. The 1014 patients who had undergone a popliteal block for foot and/or ankle orthopedic surgery were analyzed for short and long-term neuropathic complications. The collected data consisted of tourniquet time, pressure, and location as well as the method of finding the fossa nerve, adjuncts used, and patient medical history. Data were analyzed using chi-square, Fisher's exact, and t tests for analysis with a significance value of P < .05. RESULT: Of these 1014 patients, 52 patients (5%) developed deleterious symptoms likely resulting from their popliteal block, and 7 (0.7%) of these were unresolved after their last follow-up. No immediately apparent underlying causes were determined for these complications. CONCLUSION: The frequency of a neuropathic complication following a popliteal nerve block was notably higher in the early postoperative period than indicated in the past. The proportion of patients with unresolved neuropathic symptoms at last follow-up is comparable to that previously reported in the literature. LEVEL OF EVIDENCE: Level IV, retrospective case series.