Overuse injuries to the elbow in the throwing athlete are common. Ulnar collateral ligament reconstruction (UCLR), commonly known as Tommy John surgery, is performed on both recreational and high-level athletes. There is no current literature regarding the incidence and demographic distribution of this surgical procedure in relation to patient age, location within the Unites States, and sex. To determine the current demographic distribution of UCLR within the US population included in the PearlDiver database. Descriptive epidemiology study. A retrospective analysis of the PearlDiver supercomputer database, a private-payer database, was performed to identify UCLR procedures performed between 2007 and 2011. The Current Procedural Terminology (CPT) code 24346 (reconstruction of the ulnar collateral ligament of the elbow with the use of a tendinous graft) was used. Between 2007 and 2011, a total of 790 patients underwent UCLR. The average (±SD) annual incidence was 3.96 ± 0.38 per 100,000 patients for the overall population but was 22 ± 3.4 for patients aged 15 to 19 years. The overall average annual growth was 4.2%. There were 695 males and 95 females. The 15- to 19-year-old patients accounted for significantly more procedures than any other age group (56.8%; P < .001), followed by 20- to 24-year-olds (22.2%). The incidence of UCLR in the 15- to 19-year-old group increased at an average rate of 9.12% per year (P = .009). Significantly more UCLR procedures were performed in the southern United States than in any other region (P < .001). The number of procedures significantly increased over time (P = .039). According to this database of a privately insured population, UCLR was performed significantly more in patients aged 15 to 19 than any other age group. The average annual incidence of UCLR per 100,000 people for patients aged 15 to 19 was 22 ± 3.4. Further, this database showed that the number of UCLR procedures is increasing over time. Further work should address risk reduction efforts in this at-risk population.

Surgical treatment of symptomatic femoroacetabular impingement (FAI) aims to improve symptoms and potentially delay initiation of hip osteoarthritis and prevent progression to end-stage hip osteoarthritis and possible total hip arthroplasty (THA). Hip arthroscopy and open surgical hip dislocations are the 2 most common surgical approaches used for this condition. To perform a comparative systematic review to determine whether there is a significant difference in clinical outcomes and progression to THA between hip arthroscopy and open surgical hip dislocation treatment for FAI at minimum medium-term follow-up. Systematic review and meta-analysis. A systematic review of the MEDLINE database by use of the PubMed interface was performed. Minimum mean follow-up for included studies was set at 36 months. English-language studies with a minimum mean medium-term time frame evaluating outcome after arthroscopic or open treatment of FAI were included. Independent t tests, Kaplan-Meier survival analysis, and weighted mean pooled cohort statistics were performed. A total of 16 studies met inclusion criteria. There were 9 open surgical hip dislocation studies and 7 hip arthroscopy studies. Open studies included 600 hips at a mean follow-up of 57.6 months (4.8 years; range, 6-144 months). Arthroscopic studies included 1484 hips at a mean follow-up of 50.8 months (4.2 years; range, 12-97 months). With THA as an outcome endpoint, there was an overall survival rate of 93% for open and 90.5% for arthroscopic procedures (P = .06). Advanced age and preexisting chondral injury were risk factors for progression to THA after both treatments. Direct comparison among disease-specific outcome instruments between the 2 procedures was limited by outcome measure heterogeneity; however, both treatments demonstrated good outcomes in their respective scoring systems. Notably, hip arthroscopy was associated with a higher general health-related quality of life (HRQoL) score on the 12-Item Short-Form Survey physical component score (P < .001). Both hip arthroscopy and open surgical hip dislocation showed excellent and equivalent hip survival rates at medium-term follow-up with hip-specific outcome measures, demonstrating equivalence between groups. However, hip arthroscopy was shown to have superior results regarding general HRQoL in comparison to open treatment. An increased understanding of the natural history of FAI remains warranted, with further studies needed to assess long-term outcomes for patients with FAI.

Nutritional status has become increasingly important in optimizing surgical outcomes and preventing postoperative infection and wound complications. However, currently, there is a paucity in the orthopaedics literature investigating the relationship between nutritional status and wound complications following total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine the prevalence of (1) postoperative infections, (2) wound complications, (3) concomitant infection with wound (CoIW) complication, and (4) infection followed by wound complication by using (1) albumin, (2) prealbumin, and (3) transferrin levels as indicators of nutritional status. These four different outcome measures were chosen as they are encountered commonly in daily clinical practice. A retrospective review of a national private payer database for patients who underwent TKA with postoperative infections and wound complications stratified by preoperative serum albumin (normal: 3.5–5 g/dL), prealbumin (normal: 16–35 mg/dL), and transferrin levels (normal: 200–360 mg/dL) between 2007 and 2015 was conducted. Patients were identified by Current Procedural Terminology (CPT), International Classification of Disease, ninth revision (ICD-9) codes, and Logical Observation Identifiers Names and Codes (LOINC). Linear regression was performed to evaluate changes over times. Yearly rates of infection, as well as a correlation and odds ratio analysis of nutritional laboratory values to postoperative complications, were also performed. Our query returned a total of 161,625 TKAs, of which 11,047 (7%) had postoperative wound complications, 18,403 (11%) had infections, 6,296 (34%) had CoIW, and 4,877 (4%) patients with infection developed wound complications. Albumin was the most commonly ordered laboratory test when assessing complications (96%). Wound complications, infections, CoIW, and infection with wound complications after were higher in those below the normal range: albumin <3.5 g/dL (9, 14, 6, and 5%), prealbumin <15 mg/dL (20, 23, 13, and 12%), and transferrin <200 mg/dL (12, 17, 6, and 6%). Preoperative albumin, prealbumin, and transferrin values falling below the normal range represented an increased risk for postoperative complications. Those patients who were in the normal range, however, did not have an increased risk. Therefore, our results suggest that preoperative nutritional optimization can play an important role in reducing the risk for postoperative complications.