Preventing Infection After Transmetatarsal Amputation (TMA): What We Know

 

GLP-1s appear to be more than weight loss drugs, potentially offering direct joint protection and dramatically reducing surgical risk. 

 

By the numbers



Recent research demonstrates significant clinical benefits across multiple measures:

 

• 40% of obese patients with known hip arthritis prescribed a GLP-1 showed a reduced risk of hip replacement within one year, based on data from 239,000+ patients.

• 25% of obese patients with known knee arthritis on a GLP-1 demonstrated a reduced risk of knee replacement within one year. 

• 1.0% versus 1.8% represents the prosthetic joint infection rates in morbidly obese patients on GLP-1s compared to those not on them – nearly half the risk. Readmissions also dropped from 8.9% to 5.3%.

 

Bottom line

 

As GLP-1 adoption grows, orthopedic programs should expect meaningful declines in both primary arthroplasty volume and post-operative complications.

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The Role of Surgical Scheduling and Workflow in Cervical Spine Fusion Outcomes

by Vince Vacketta, DPM

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The Role of Surgical Scheduling and Workflow in Cervical Spine Fusion Outcomes

by Vince Vacketta, DPM

 

Does the time of day a cervical spinal fusion begins, or whether the surgery crosses an operating room shift change, affect patient outcomes?

 

Researchers conducted a study examining three timing factors – case start time, operating room shift changes, and case order – to determine whether scheduling and workflow influence outcomes after cervical spinal fusion in patients with similar demographics and comorbidities.

 

Key study findings

 

• Intraoperative shift change: Associated with a 2.04-day longer length of stay and higher likelihood of non-home discharge.

• Later cases (2nd or beyond): Associated with a 1.62-day longer length of stay.

• Second case or later cases: Associated with lower odds of one-year revision spine surgery.

• Start time alone: Less influential than case order and shift transitions on patient outcomes overall.

 

Understanding the impact

 

These findings challenge the common assumption that later cases inevitably lead to worse outcomes due to surgeon fatigue or operating room inefficiency. Instead, case order may influence recovery logistics more than surgical success. Patients undergoing later cases in the day may stay in the hospital longer, especially if a shift change occurs, but longer-term surgical durability may not suffer – and may even improve.

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The Five-Second Rule for Surgical Implants: Now With Higher Stakes

 

Surgeons drop implants more often than you'd think. When this happens, it’s not just embarrassing, it’s a genuine safety risk.

 

The uncomfortable truth is that operating room floors are microbial party venues. Pathogens readily colonize these surfaces, so a dropped implant is a potential post-op surgical infection waiting to happen. 

 

What surgeons do when an implant is dropped

 

• Most delay surgery over using a contaminated implant.

• Some soak the implant in antiseptic solution to reduce bacterial contamination.

• Some improvise with a temporary placeholder, then replace it later with a sterile one.

 

New evidence changes the game

 

A randomized bench study confirmed that dropped polyethylene liners pick up dangerous bacteria almost instantly. However, not all decontamination methods are equally effective. 

 

• Effective approaches: 

• Chlorhexidine-alcohol immersion significantly cuts bacterial load

• Povidone-iodine immersion is equally effective at cutting bacterial contamination

 

• Ineffective approaches:

• Ethanol alone is notably inferior

• No treatment to decontaminate an implant is not an option

 

Bottom line

 

Always replace a dropped implant if one is available. When you can't, use a chlorhexidine-alcohol or iodine — not ethanol, not optimism. The operating room floor always wins unless you come prepared. Now, someone please write the guidelines.