Thank you very much. My disclosures are listed on the website. In 2001, we published the first scientific article on hip arthrospian athletes and we found that 60% of the intra-articular disorders went unrecognized for an average of seven months during initial treatment. More recently, John Clohissy from St. Louis noted that young adults with non-arthritic hip disorders were evaluated by an average of 4.2 healthcare providers before a diagnosis was established. In 2004, we looked at the diagnostic accuracy of various imaging and the response to fluoroscopically guided intra-articular injection and we found a 90% reliability with the response to intra-articular injection, but there are a couple of caveats with these fluoroscopically guided injections. First, they have to go to the radiology department, get checked in, they got to take their clothes off and they're being directed around by some strangers they don't know and then when you try to ask them how they responded to the injection, oftentimes they're so busy telling you how horrible the experience was that it sort of defeats the purpose. So we've been doing ultrasound guided injections in the office and our experience in published data has been that this is vastly superior in terms of patient convenience and patient discomfort compared to fluoroscopic injections and there's minimal learning curve. Certainly FAI is the 600-pound gorilla in the room and regardless of the suddenness of onset of symptoms with FAI, it's the culmination of the cumulative effect of a disorder that's been present since childhood and often the insidious onset may dull the patient's perception of how much of an issue the hip may be. They're compensating for this long before the joint symptoms first develop and the compensatory problems may obscure the joint issues. So to me, assessing complex hip problems without benefit of ultrasonography is like trying to practice cardiology without a stethoscope, you're missing a critically important instrument in your armamentarium. As far as our reasoning behind intraarticular injections of steroids, there are really two reasons for patients that are potentially a candidate for arthroscopy. Number one is to reduce the joint symptoms allowing the patient to more effectively participate in supervised physical therapy, correcting the other issues that may be going on around the joint or we may just be using it as a last line of non-surgical treatment to try to see if surgery can be avoided. And then this thing came out, this article where they saw a two-fold increased risk of post-op infection for people that had an intraarticular injection within three months of arthroscopy. They had 339 cases from an insurance and Medicare database but what really caught my eye on this report was they had a 1% infection rate in the control group. And we have had one post-op infection for an overall rate of about a little over 1, 1 hundredth of 1% so it can happen but it ought to be exceedingly rare. So the purpose of this study is to report the incidence of post-operative infections among patients undergoing an intraarticular steroid injection within three months of arthroscopy. Our hypothesis was that with an appropriate strategy, these type of injections may be associated with an acceptably low rate of post-operative complications. Far as our methods, we retrospectively reviewed 500 consecutive cases who had a steroid injection and subsequently underwent arthroscopic surgery within three months. All injections were performed by a single mid-level provider, namely my nurse practitioner and all arthroscopic procedures were performed by a single surgeon. In general, we tried to delay arthroscopy for about four to six weeks after an intraarticular injection. Partly this is to avoid any deleterious effects of the steroid but also it can take four to six weeks to figure out whether the injection is really making a meaningful difference for them. So it doesn't make sense to put steroids in somebody's joint and plan to operate on them within a week or so. This is a real-time assessment from beginning to end of our technique. They're looking under ultrasound. You'll see this come around. We spray ethyl chloride on the skin, no other injections in the skin, the needle going in. You can see it on the screen going in underneath the capsule and as she's injecting, lifting the capsule up off the anterior neck of the femur. And the whole process literally takes seconds and that's the end. So as far as our results, we had about three to one females to males. Average time between injection and surgery was eight and a half weeks. Most of these were FAI cases and we had no post-op infections among 500 cases for a rate of zero percent. So to summarize, in my opinion, ultrasound guided injections are an essential element in the diagnosis and treatment of hip disorders and this data supports that with careful attention to the details of both techniques, arthroscopy can be safely performed within three months of an intra-articular injection. Thank you very much. Thank you.

ultrasound-guided injections

hip disorders

intra-articular disorders

fluoroscopically guided injections

athletes