Sports hernia: diagnosis and treatment highlighting a minimal repair surgical technique.

Groin injuries are a common occurrence in elite-level athletes. These injuries can cause significant pain and disability, leading to prolonged periods of inactivity and consternation among athletes, coaches, athletic trainers, and physicians alike. The differential diagnosis for groin pain is vast and spans multiple disciplines, including orthopaedics, general surgery, urology, gynecology, and neurology. Sports hernias are one cause of chronic groin pain in athletes and are distinct entities from classic hernias. They are often caused by a deficient posterior wall of the inguinal canal, but may also involve concurrent injuries, such as conjoint and adductor tendinopathies and nerve entrapment. Understanding the complex lower abdominal, pelvic, and hip anatomy and pathophysiology of sports hernias is crucial to making an accurate diagnosis and providing appropriate treatment options. Newer, less invasive surgical repair techniques show promising early results in improving pain and decreasing recovery time.

Total hip arthroplasty revision: a decade of change.

We studied the incidence, indications, and changing patterns of total hip arthroplasty (THA) revision by comparing all consecutive THA revisions performed at a single institution between July 1989 and June 1991 with all those performed at the same institution between January 2000 and December 2000. Aseptic loosening was the main reason for THA failure during both periods. Between the periods, the number of revisions for polyethylene wear, instability, and leg-length discrepancy increased, and the number of revisions for conversion of failed hemiarthoplasty to THA and for deep infection decreased significantly. We evaluate the reasons for these trends in an attempt to identify preventable causes of failure and to stimulate further research on prevention.

Risk factors for surgical site infection in the patient with spinal injury.

STUDY DESIGN: A retrospective chart review of 1561 patients with spinal injury was conducted over a 4-year period. OBJECTIVES: To determine the rate of surgical site infection in the spinal trauma population, to compare infection rates after spinal operations for elective and traumatic indications, and to identify risk factors for postoperative wound infections in the traumatic subpopulation. SUMMARY OF BACKGROUND DATA: Surgical site infection after spinal operations is a dreaded complication. Risk factors have been investigated previously, but the subset of patients with acute traumatic spinal injury may be distinct. METHODS: The hospital's infection control program was used to identify surgical site infections after spinal operations, and infection rates were calculated. Data including patient characteristics, severity of injury indicators, surgical factors, and perioperative management factors were collected for the patients presenting with acute spinal injury over a 4-year period. RESULTS: Postoperative wound infections developed in 24 of 256 patients. This infection rate of 9.4% was significantly (P < 0.001) higher than for elective spinal operations during the same period (3.7%). Risk factors found to be independently significant included delay until operation, increased postoperative intensive care unit stay, single (neurosurgical or orthopedic) versus combined operative team. CONCLUSIONS: Risk factors for surgical site infection in the acute trauma setting are identified. Two surgical teams may be involved without causing a higher rate of infection.

Failed tarsal tunnel syndrome surgery.

Failed tarsal tunnel syndrome surgeries are better prevented than treated. Outcomes for revision procedures are significantly worse than for primaries. Failures should be treated with conservative measures first, then surgery for refractory cases. An adequate release must be ensured, and associatedpathologies must be addressed. One should consider containment procedures for adhesive neuritis and PNS for intraneural or intractable pain.