Coleman, Struan H.

Purpose To evaluate the association of preoperative intra‐articular hip injection with surgical site infection after hip arthroscopy. Methods A large administrative database was used to identify all patients undergoing hip arthroscopy from 2007 to 2015 within a single private insurer and from 2005 to 2012 within Medicare in the United States. Those that received an ipsilateral preoperative intra‐articular hip injection were identified. The patients were then divided into the following groups based on the interval between preoperative injection and ipsilateral hip arthroscopy: (1) <3 months, (2) 3 to 6 months, and (3) 6 to 12 months. These groups were compared to a control group composed of patients with no history or a remote history (>12 months) of preoperative hip injection. Patients developing a surgical site infection within 6 months following hip arthroscopy were identified using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes associated with infection. Groups were compared using a multivariate logistic regression analysis to control for age, gender, body mass index, smoking status, alcohol usage, and multiple medical comorbidities including diabetes mellitus, hemodialysis use, inflammatory arthritis, and peripheral vascular disease. Results In total, 19% of privately insured and 6% of Medicare patients received a hip injection within 12 months of hip arthroscopy. The overall infection rate in privately insured and Medicare patients was 1.19% and 1.10%, respectively. Preoperative hip injection within 3 months of surgery was associated with a significantly higher risk of postoperative infection versus controls (2.16%, odds ratio [OR] 6.1, P < .001, for privately insured group; 2.80%, OR 1.99, P = .037, for Medicare group). In contrast, preoperative hip injection given after more than 3 months of surgery was not associated with an increased risk of postoperative infection versus controls. Conclusions Risk of infection after hip arthroscopy increased when preoperative intra‐articular hip injections were given within 3 months of surgery. Level of Evidence Level III, retrospective comparative study.

Background: Although sliding occurs frequently in professional baseball, little is known about the epidemiology and effect of injuries that occur during sliding in this population of elite athletes. Purpose: To describe the incidence and characteristics of sliding injuries, determine their effect in terms of time out of play, and identify common injury patterns that may represent appropriate targets for injury prevention programs in the future. Study Design: Descriptive epidemiologic study. Methods: All offensive sliding injuries occurring in Major League Baseball (MLB) and Minor League Baseball (MLB) that resulted in time out of play during a span of 5 seasons (2011-2015) were identified. In addition to player demographics, data extracted included time out of play, location on field where injury occurred, level of play, treatment (surgical vs nonsurgical), direction of slide (head vs feet first), body region injured, and diagnosis. Descriptive statistics were used to describe the distribution of these injuries, and injury rates were calculated per slide. Results: From 2011 to 2015, 1633 injuries occurred as a result of a slide. The total number of days missed per season was 4263. Surgical intervention was required for 134 (8.2%) injuries, and the mean days missed was 66.5 for players treated surgically and 12.3 days for players treated nonoperatively ( P < .001). MLB players were more likely than MiLB players to require surgical intervention (12.3% vs 7.5%, P = .019). Injuries to the hands/fingers represented 25.3% of all injuries and 31.3% of those requiring surgery. Although the majority of injuries occurred at second base (57%), the per-slide injury rate was similar across all bases ( P = .991). The estimated overall frequency of injury in MLB was once per every 336 slides, and the rate of injury for head- and feet-first slides was 1 in 249 and 413 slides, respectively ( P = .119). Conclusion: Injuries occurring while sliding in professional baseball result in a significant amount of time out of play for these elite athletes. Injuries occurring at second base and those occurring to the hands and fingers were most prevalent and may be an appropriate target for future injury prevention programs.

Purpose The purpose of this prospective randomized study was to compare the outcomes of arthroscopic labral repair and selective labral debridement in female patients undergoing arthroscopy for the treatment of pincer‐type or combined pincer‐ and cam‐type femoroacetabular impingement. Methods Between June 2007 and June 2009, 36 female patients undergoing arthroscopic hip treatment for pincer‐ or combined‐type femoroacetabular impingement were randomized to 2 treatment groups at the time of surgery: labral repair or labral debridement. The repair group comprised 18 patients with a mean age of 38; the debridement group comprised 18 patients with a mean age of 39. All patients underwent the same rehabilitation protocol postoperatively. At a minimum of 1 year, all patients were assessed using a validated Hip Outcome Score (HOS) to determine hip function, and also completed a simple subjective outcome measure. Results All 36 patients were available for follow‐up at an average time of 32 months (range, 12 to 48). In both groups, HOSs for activities of daily living (ADL) and sports improved significantly from before surgery to the final follow‐up ( P < .05). The postoperative ADL HOS was significantly better in the repair group (91.2; range, 73 to 100) compared with the debridement group (80.9; range, 42.6 to 100; P < .05). Similarly, the postoperative sports HOS was significantly greater in the repair group (88.7; range, 28.6 to 100) than in the debridement group (76.3; range, 28.6 to 100; P < .05). Additionally, patient subjective outcome was significantly better in the labral repair group ( P = .046). Conclusions Arthroscopic treatment of femoroacetabular impingement with labral repair in female patients resulted in superior improvement in hip functional outcomes compared with labral debridement. In addition, a greater number of patients in the repair group subjectively rated their hip function as normal or nearly normal after surgery compared with the labral debridement group. Level of Evidence Level I, prospective randomized study.