Based on a previously reported study, it is hypothesized that Tönnis 2 changes may not be a harbinger of poor results. The purpose is to report outcomes comparing Tönnis 2 changes to those with Tönnis 0&1 changes. Previously published outcomes (modified Harris Hip Score and return to sport) among 200 consecutive athletes undergoing arthroscopic correction of femoroacetabular impingement with minimum 1-year follow-up were correlated with the Tönnis grade. Independent variables of gender and age were also evaluated. Average age was 28.6 years (range 11–60), with 148 males and 52 females. The average improvement was Tönnis 0 23.1 points (n = 37), Tönnis 1 20.6 points (n = 113) and Tönnis 2 16.4 points (n = 48). A trend (P = 0.055) towards lower scores with increasing Tönnis grade was not statistically significant. There was both statistically (P < 0.01) and clinically (>8 patients) significant improvement across all Tönnis grades, and there was no statistically significant difference between Tönnis 0 and 1 compared with Tönnis 2 (P = 0.078). The percent that returned to sport was as follows: Tönnis 0 95%, Tönnis 1 92% and Tönnis 2 85%. A trend (P = 0.098) towards lower rates of return to sport with increasing Tönnis grade was not statistically significant, and there was no statistically significant difference between Tönnis 0 and 1 compared with Tönnis 2. Within each grade, there was no correlation with age, such that increasing age did not reflect lower scores. There was also no correlation with gender. Statistically and clinically successful outcomes can be encountered among athletes with Tönnis 2 radiographic features.

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Background: Ultrasound-guided intra-articular hip injections have become a mainstay in the diagnosis and treatment of various hip disorders. Concern arises with regard to the chronological proximity of an injection to subsequent arthroscopy. Thus, the purpose of this study was to report the risk of postoperative infections among patients who have undergone an intra-articular corticosteroid injection within 3 months of hip arthroscopy. Methods: In-office, ultrasound-guided, intra-articular hip injections were first performed at this center in 2011. Corticosteroid is used for therapeutic purposes in the presence of painful hip conditions to reduce joint symptoms, either to allow for more effective supervised physical therapy or simply as a last line of nonoperative management. A retrospective review of patient records was performed, identifying all patients who had undergone arthroscopy and had received an intra-articular injection of corticosteroid at this institution within 3 months of the surgical procedure. Results: Five hundred patients underwent an ultrasound-guided intra-articular injection of corticosteroid within 3 months of a hip arthroscopy. The mean age was 37.6 years (range, 14 to 74 years), with 112 male patients and 388 female patients. The mean time between the injection and the arthroscopy was 59 days (range, 15 to 92 days). There were no postoperative infections. Conclusions: When both the injection and the procedure are performed in a tertiary referral center, an ultrasound-guided intra-articular injection of corticosteroid within 3 months prior to arthroscopy, at a mean time of 59 days, resulted in no postoperative infections among 500 cases and can represent an acceptably low rate of complication. To our knowledge, this is the largest reported series on this subject. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Piriformis syndrome is an elusive condition that likely is overlooked and overdiagnosed in equal proportions. Image-guided injection of the muscle is an essential element in the assessment and management of this disorder. Ultrasonography allows visualization of the anatomy of the piriformis and its relation with the sciatic nerve. Ultrasound-guided injection of the muscle can be performed in an effective, reproducible fashion and, with careful attention to the details of the procedure, can be performed with minimal morbidity to the patient. This method has the advantage of being exceptionally well tolerated by the patient and can be performed in the office with minimal patient inconvenience and the opportunity for a real-time assessment of the patient's response to the injection. Our ultrasound-guided technique of piriformis muscle injection is detailed in this article.

Ultrasound-guided intra-articular injection has become a mainstay in the diagnosis and treatment of a variety of hip disorders. It is the single greatest adjunct to history and examination in the clinical assessment of hip problems and has substantial therapeutic value in the conservative management of symptomatic disorders, especially when used in conjunction with supervised physical therapy.