Despite growing numbers of scientific publications on the optimal antibiotic treatment for diabetic foot infections, the data on the adult population with non-diabetic (postsurgical) foot infections is limited. Therefore, one of the largest single-center databases at the Balgrist University Hospital in Zurich, Switzerland, was established between January 2014 and August 2022. Using a case–control study design, we retrospectively investigated failures of combined surgical and antibiotic therapy for surgical site foot infections (SSIs). Overall, 17.4% of the episodes experienced therapeutic failures, particularly in patients with infected ankle prostheses. However, age, biological sex, pathogens, the duration of post-debridement antibiotic treatment, the number of surgical debridements, or the use of negative-pressure wound care altered the failure risk. In the multivariate logistic regression analyses, the duration of postsurgical antibiotic use was completely indifferent (as a continuous variable with an odds ratio of 1.0 and a 95% confidence interval ranging from 0.96 to 1.03) when stratified into inter-tertiary groups. Our findings suggest that shorter courses of systemic antibiotics may be appropriate in non-diabetic adults, supporting better antibiotic stewardship. Ongoing randomized controlled trials are under way to investigate which patients might safely receive shorter antibiotic treatments for surgical site infections following elective foot and ankle procedures.

Whereas there is an increasing number of scientific publications investigating the optimal anti-biotic treatment for diabetic foot infections, we are lacking corresponding data in the adult non-diabetic (postsurgical) foot infection population. We therefore established one of the largest single-center databases on this topic and retrospectively investigate failures of a combined sur-gical and antibiotic therapy for surgical site foot infections. Overall, 17.4% of the episodes expe-rienced any therapeutic failures; especially among the infected ankle prostheses. In contrast, neither the age, the biological sex, pathogens, the duration of post-debridement antibiotic treatment, the number of surgical debridement, or the use of negative-pressure wound care could alter the failure risk. In multivariate logistic regression analyses, the duration of postsur-gical antibiotic use was completely indifferent (as a continuous variable with odds ratio 1.0, 95% confidence interval 0.96-1.03), or when stratified into inter-tertiary groups. Our results poten-tially enable shorter applications of systemic antibiotics in favor of a better stewardship in the non-diabetic adult population. Consecutive prospective-randomized trials are under way to identify eligible patient populations for a potentially shorter durations in surgical site infections after elective foot and ankle surgery.

Long-term data at 15 years following implantation of reverse total shoulder arthroplasty (rTSA) is very limited. It was the aim of this study to analyze patients at a minimum of 15 years following rTSA implantation. A prospectively followed database of rTSAs performed at a tertiary referral center was analyzed at a minimum follow-up of 15 years. Kaplan-Meier survival curves were used to estimate time to complication and reoperation/revision rates and to calculate predictive factors. Clinical outcomes included the absolute and relative Constant-Murley score (CSa and CSr), Subjective Shoulder Value (SSV), range of motion including CS internal rotation (CS IR) and CS pain. The radiographic measurement included analysis of notching, radiolucent lines, heterotopic ossification, stress shielding and tuberosity resorption. A total of 258 shoulders (249 patients, median age 72 [75% IQR, 66 to 78] years, 62% female) underwent rTSA implantation in the specified period. Kaplan-Meier Survival analysis revealed a complication-free rate of 80% (IQR, 78% to 83%) and 76% (IQR, 70% to 81%) and a reoperation-free rate of 84% (IQR, 80% to 89%) at 10 and 15 years, respectively. Risk factors for complications were younger age (Hazard ratio (HR) 0.97), female gender (HR 2.04), and revision surgery as indication (HR 2.08). Of those 258 shoulders, 52 rTSAs (52 patients, median age 64 (IQR, 59 to 70) years, 46% female) were available for complete clinical and radiographic analysis at a minimum follow-up of 15 years (median 15.1 (IQR, 14.9 to 16,6) years). The initial improvements observed for most clinical parameters could be maintained from 2-years to mid-term and long-term follow-up at 10 and 15 years, respectively, including a CSa of 64 (IQR, 46 to 71), CSr of 79% (IQR, 60% to 86%), SSV of 80% (IQR, 60% to 93%), CS pain of 15.0 (IQR, 10.0 to 15.0), abduction of 120° (IQR, 88° to 145°), external rotation of 20° (IQR, 10° to 40°), and CS IR of 4.0 (IQR, 2.0 to 8.0), as well as strength of 2.13 (IQR, 0.00 to 3.45) kg at 15 years follow-up. Only flexion showed worsening over time from 130° (IQR, 100° to 150°) at 2 years to 115° (IQR, 94° to 130°) at 15 years postoperatively. All radiographic parameters progressed from preoperatively to 10 years postoperatively with no further progression. RTSA provides a stable clinical and radiographic outcome at long-term follow-up of at least 15 years. However, complication and revision rates are still high.