April 18, 2024

Here's what's interesting in foot & ankle this week ...

Sterile Wounds Seemed Like a Good Idea

Sprinkling some vancomycin powder (vanco) in a wound seems like a reasonable idea. First adopted in total joint arthroplasty, it has gained popularity in foot and ankle. But where is the evidence and could we be unintentionally making things worse?

Vanco in wounds for total hip arthroplasty (THA) did not decrease infection

Doxey et al. analyzed 523 patients who underwent primary THA with intrawound vancomycin powder (IVP) and 670 patients with similar age, BMI, and sex who did not receive IVP during surgery. Overall, patients who received IVP had a higher rate of culture-positive prosthetic joint infections (PJI) vs. patients who did not receive IVP (1.7% vs. 0.3%). 

New recommendations THA regarding IVP

These findings suggest that the role of IVP in THA may not provide protective effects against PJI and may even be associated with deleterious effects. The authors concluded that “due to the significant association with surgical site morbidity, we currently recommend against the use of IVP in primary THA.” 

Minimally Invasive Surgery (MIS) Training Wheels With First Metatarsal Phalangeal Joint (MTPJ) Fusions

by Vince Vacketta, DPM

The indications and utilization of minimally invasive techniques in foot and ankle surgery continue to grow at an exponential rate. Joint-sparring bunion correction has led the way in popularizing MIS techniques though there still remains a strong division between early adopters and skeptics. 

As indications and applications of MIS techniques continue to expand, new research presents a common ground for MIS believers and skeptics to stand on with the MIS 1st MTPJ fusion. With smaller incisions and comparable outcomes to open 1st MTPJ fusion, MIS 1st MTPJ fusion is an excellent procedure to join the MIS movement. Take a deep dive below to understand the how and why: 

How it's Done: https://www.fastracjournal.org/article/S2667-3967(21)00041-0/fulltext

The Data:

- https://journals.sagepub.com/doi/10.1177/10711007241238221

- https://www.fastracjournal.org/article/S2667-3967(23)00071-X/fulltext

Science and Clinical Experience Total Talus Replacement (TTR)

The total talus is in every foot and ankle discussion on challenging ankle problems. This innovative technology, approved under a Humanitarian Device Exemption (HDE), has had a welcome reception. While the tibiotalocalcaneal fusions are not that great, the concept of talus replacement is attractive. It’s time for a well-designed trial on TTR and Restor3d is leading the way.

The details

In the study "Prospective Evaluation of Clinical and Radiographic Outcomes Following Total Talus Replacement (PROCLAIM)," 50 subjects will receive total talus replacement. The main goal is to assess both the safety and probable benefit of the procedure. Patient-reported outcomes and pain scales will be measured using validated scoring systems. The safety endpoint is defined by the absence of device-related SAE and subsequent secondary surgical intervention (SSSI) on the affected joints at five years. Click here for full details.

Foot & Ankle Stock Ticker, 4/17/2024

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