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Article ; Online: Total Joint Arthroplasty in Patients Who Are Obese or Morbidly Obese: An Ethical Analysis.

Lachance, Andrew D / Steika, Roman / Lutton, Jeffrey / Chessa, Frank

The Journal of bone and joint surgery. American volume

2024 Volume 106, Issue 7, Page(s) 659–664

MeSH term(s)	Humans ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Arthroplasty, Replacement, Knee ; Ethical Analysis ; Postoperative Complications/surgery ; Retrospective Studies ; Body Mass Index
Language	English
Publishing date	2024-02-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	220625-0
ISSN	1535-1386 ; 0021-9355
ISSN (online)	1535-1386
ISSN	0021-9355
DOI	10.2106/JBJS.23.00617
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Article ; Online: Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery?

Lachance, Andrew D / Giro, Margaret E / Edelstein, Alexander / Klos, Eliza / Lee, Wonyong

Foot & ankle orthopaedics

2024 Volume 9, Issue 1, Page(s) 24730114231224796

Abstract: 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 ...

Abstract	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 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.
Language	English
Publishing date	2024-01-28
Publishing country	United States
Document type	Journal Article
ISSN	2473-0114
ISSN (online)	2473-0114
DOI	10.1177/24730114231224796
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Article: 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.

Lachance, Andrew D / Edelstein, Alexander / Stilwell, Mason / Lutton, Jeffrey

Arthroplasty today

2023 Volume 24, Page(s) 101269

Abstract: 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 ... ...

Abstract	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 ( 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.
Language	English
Publishing date	2023-11-09
Publishing country	United States
Document type	Journal Article
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2023.101269
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Article ; Online: Suture button fixation yields high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries: A systematic review.

Lachance, Andrew D / Giro, Margaret Elizabeth / Edelstein, Alexander / Lee, Wonyong

Journal of ISAKOS : joint disorders & orthopaedic sports medicine

2023 Volume 8, Issue 6, Page(s) 474–483

Abstract: 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 ...

Abstract	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.
MeSH term(s)	Humans ; Return to Sport ; Fracture Fixation, Internal/methods ; Fractures, Bone/surgery ; Patient Reported Outcome Measures ; Sutures
Language	English
Publishing date	2023-08-21
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ISSN	2059-7762
ISSN (online)	2059-7762
DOI	10.1016/j.jisako.2023.08.004
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Article: Conversion of Patellofemoral Arthroplasty to Robotic-Assisted Total Knee Arthroplasty.

Lachance, Andrew D / Steika, Roman / Lutton, Jeffrey / Austin, David

Arthroplasty today

2023 Volume 23, Page(s) 101215

Abstract: Conversion of patellofemoral arthroplasty to total knee arthroplasty (TKA) has been described as similar to primary TKA, although it may come with more challenges and worse outcomes. With the increased rate of revision following conversion TKA vs primary ...

Abstract	Conversion of patellofemoral arthroplasty to total knee arthroplasty (TKA) has been described as similar to primary TKA, although it may come with more challenges and worse outcomes. With the increased rate of revision following conversion TKA vs primary TKA, robotically assisted TKA provides an alternative technique to manual conversion. We present 3 cases of robot-assisted conversion of prior patellofemoral arthroplasty to TKA with good mechanical and clinical outcomes and no intraoperative complications.
Language	English
Publishing date	2023-09-18
Publishing country	United States
Document type	Case Reports
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2023.101215
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Article ; Online: Anterior Compartment Neurovascular Bundle Entrapment in a Minimally Displaced Distal Tibial Fracture: A Case Report.

Lachance, Andrew D / Shields, Margaret V / Ryan, Scott P

JBJS case connector

2022 Volume 12, Issue 1

Abstract: Case: A 29-year-old woman presented with a low-energy, minimally displaced pilon fracture with progressive pain and paresthesias in the affected foot, ultimately requiring open reduction and internal fixation. Intraoperatively, the deep peroneal nerve ... ...

Abstract	Case: A 29-year-old woman presented with a low-energy, minimally displaced pilon fracture with progressive pain and paresthesias in the affected foot, ultimately requiring open reduction and internal fixation. Intraoperatively, the deep peroneal nerve and anterior tibial artery and vein were entrapped within the fracture. After freeing the bundle and fixing the fracture, the paresthesias improved and ultimately resolved. Conclusion: Injury to the anterior leg compartment neurovascular structures should be considered in low-energy, minimally displaced pilon fractures. In this instance, progressive neurologic symptoms not consistent with the radiographic findings indicated the patient for surgical exploration and fixation.
MeSH term(s)	Adult ; Female ; Fracture Fixation, Internal ; Humans ; Open Fracture Reduction ; Tibial Arteries/diagnostic imaging ; Tibial Arteries/surgery ; Tibial Fractures/complications ; Tibial Fractures/diagnostic imaging ; Tibial Fractures/surgery
Language	English
Publishing date	2022-01-20
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2160-3251
ISSN (online)	2160-3251
DOI	e21.00647
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Article ; Online: Atlantoaxial Spondyloptosis with Type II Odontoid Fractures: A Report of 2 Cases.

Lachance, Andrew D / Gerstl, Jakob V E / Florman, Jeffrey E

JBJS case connector

2022 Volume 12, Issue 4

Abstract: Case: Two patients with delayed presentations of neck pain and fixed kyphotic deformity after trauma were found to have atlantoaxial spondyloptosis (AAS) with type II dens fractures. Owing to the rarity of AAS, outcomes and optimal treatment are not ... ...

Abstract	Case: Two patients with delayed presentations of neck pain and fixed kyphotic deformity after trauma were found to have atlantoaxial spondyloptosis (AAS) with type II dens fractures. Owing to the rarity of AAS, outcomes and optimal treatment are not well understood. In both cases, closed reduction was achieved with a dynamic overhead traction setup, followed by posterior surgical stabilization with C1-2 screw fixation. Conclusion: Closed reduction remains a challenge because of the marked deformity of interlocking C1-C2 joints. However, patients with chronic fixed atlantoaxial dislocation due to odontoid fractures can be safely managed with closed reduction and fusion of C1-C2. Level of evidence: Level V.
MeSH term(s)	Bone Screws ; Fractures, Bone ; Humans ; Joint Dislocations/surgery ; Odontoid Process/diagnostic imaging ; Odontoid Process/injuries ; Odontoid Process/surgery ; Spinal Fractures/complications ; Spinal Fractures/diagnostic imaging ; Spinal Fractures/surgery ; Spondylolisthesis
Language	English
Publishing date	2022-10-07
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2160-3251
ISSN (online)	2160-3251
DOI	e22.00230
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Article ; Online: The efficacy and safety of tranexamic acid utilization in total ankle arthroplasty: a systematic review and meta-analysis.

Edelstein, Alexander / McDonald, John / Lachance, Andrew D / Giro, Margaret Elizabeth / Lee, Wonyong

Archives of orthopaedic and trauma surgery

2023 Volume 144, Issue 2, Page(s) 641–649

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	Humans ; Tranexamic Acid/adverse effects ; Antifibrinolytic Agents/adverse effects ; Ankle ; Blood Loss, Surgical/prevention & control ; Arthroplasty, Replacement, Hip ; Wound Infection
Chemical Substances	Tranexamic Acid (6T84R30KC1) ; Antifibrinolytic Agents
Language	English
Publishing date	2023-11-25
Publishing country	Germany
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-023-05126-z
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Article ; Online: Comparing Orthopaedic Randomized Control Trials Published in High-Impact Medical and Orthopaedic Journals.

Puzzitiello, Richard N / Lachance, Andrew D / Michalowski, Anna / Menendez, Mariano E / Salzler, Matthew J

The Journal of the American Academy of Orthopaedic Surgeons

2023 Volume 31, Issue 21, Page(s) e974–e983

Abstract: Introduction: Orthopaedic studies published in high-impact medical journals are often believed to have a high prevalence of negative or neutral results and possess methodological characteristics that may bias toward nonsurgical treatments. The purpose ... ...

Abstract	Introduction: Orthopaedic studies published in high-impact medical journals are often believed to have a high prevalence of negative or neutral results and possess methodological characteristics that may bias toward nonsurgical treatments. The purpose of this study was to compare study characteristics, methodologic quality, exposure, and outcome direction among orthopaedic randomized control trials (RCTs) published in high-impact medical and orthopaedic journals and to identify study attributes associated with greater impact. Methods: RCTs published between January 2010 and December 2020 in the five medical journals and 10 orthopaedic journals with the highest 5-year impact factors were analyzed. Inclusion criteria were RCTs reporting on orthopaedic surgical intervention compared with nonsurgical or less-invasive surgical procedures. Study characteristics, methodologic quality (Jadad scale), outcomes, and altmetric data were collected. Primary outcomes were categorized as positive (favoring surgical/more-extensive surgery), negative (favoring nonsurgical/less-extensive surgery), or neutral. Results: One hundred twenty-eight RCTs were analyzed; 26 from medical and 102 from orthopaedic journals. Studies published in medical journals included more authors ( P < 0.001), larger sample sizes ( P < 0.001), more institutions ( P < 0.001), and more often received funding ( P < 0.001). The average Jadad scale did not significantly differ between journals ( P = 0.14). The direction of the primary study outcome did not differ between journals ( P = 0.22). Average AAS and annual citation rates were higher in RCTs published in medical journals ( P < 0.001). Publication in a medical journal was the only covariate associated with higher annual citation rates ( P < 0.001) and AAS ( P < 0.001) on multivariable analyses. Discussion: High-impact medical journals do not publish orthopaedic RCTs with negative or neutral findings at a rate that significantly differs from orthopaedic journals. However, the higher impact and digital coverage of the studies published in medical journals may disproportionally influence the practices of nonorthopaedic providers. Raising awareness of critical findings published in orthopaedic journals may be particularly important for improving healthcare policies and orthopaedic referral patterns for musculoskeletal problems.
Language	English
Publishing date	2023-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200524-1
ISSN	1940-5480 ; 1067-151X
ISSN (online)	1940-5480
ISSN	1067-151X
DOI	10.5435/JAAOS-D-22-00604
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Zs.A 4048: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 274: Show issues

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Article: The Association of Season of Surgery and Patient Reported Outcomes following Total Hip Arthroplasty.

Lachance, Andrew D / Call, Catherine / Radford, Zachary / Stoddard, Henry / Sturgeon, Callahan / Babikian, George / Rana, Adam / McGrory, Brian J

Geriatric orthopaedic surgery & rehabilitation

2024 Volume 15, Page(s) 21514593241227805

Abstract: Background: Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA). Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience. The ...

Abstract	Background: Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA). Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience. The aim of this study is to investigate if there are differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season of the index procedure to improve surgeon Methods: A retrospective chart review was performed on patients undergoing primary THA at a single large academic center between January 2013 and August 2020. Demographic, operative, hospital, and PROMs were gathered from the institutional electronic medical record and our institutional joint replacement outcomes database. Results: 6418 patients underwent primary THA and met inclusion criteria. Of this patient population, 1636 underwent surgery in winter, 1543 in spring, 1811 in summer, and 1428 in fall. PROMs were equivalent across seasons at nearly time points. The average age of patients was 65 (+/- 10) years, with an average BMI of 29.3 (+/- 6). Rates of complications including ED visits within 30 days, readmission within 90 days, unplanned readmission, dislocation, fracture, or wound infection were not significantly different by season ( Conclusion: Our findings indicate no differences in complications and PROMs at 1 year in patients undergoing THA during 4 distinct seasons. Notably, patients had functional differences at the second follow-up visit, suggesting variation in short-term recovery. Patients could be counseled that they have similar rates of complications and postoperative recovery regardless of season.
Language	English
Publishing date	2024-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2589094-3
ISSN	2151-4593 ; 2151-4585
ISSN (online)	2151-4593
ISSN	2151-4585
DOI	10.1177/21514593241227805
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