In the setting of increasing student debt, a rapidly changing health care system, and growing transparency in the age of outcome reporting, residents have many factors to consider when determining which fellowship to pursue. An institutional review board-approved link to an online survey was emailed to orthopedic surgery trainees across the United States. Demographics were collected, and 14 fellowship influences were assessed using a Likert scale. A total of 360 responses were received. Of the respondents, 85.5% (n=308) were male and 14.5% (n=52) were female. Responses were received from every region of the United States and from every postgraduate year. Respondents represented the gamut of relationship status and indebtedness. Respondents were interested in all of the current major subspecialties. Pursuit of an intellectually stimulating subspecialty had the highest average Likert score (3.38), followed by variety of cases (3.26). The lowest scores were for residency program with a strong tradition of placing into a particular subspecialty (2.08) and potential to conduct research in that subspecialty (2.09). Marital status, number of children, and level of debt did not significantly affect the importance of factors in selecting a fellowship. Choice of subspecialty did influence the level of importance of various factors. Intellectual stimulation and a strong mentor were the most influential factors in the decision to pursue a given fellowship. Because fellowship is now the norm, it is important to understand the motives behind young orthopedic surgeons' career aspirations. [Orthopedics. 2017; 40(5):e820-e824.].

BACKGROUND Periprosthetic hip infection treatment remains a significant challenge for orthopedics. Some studies have suggested that methicillin resistance and gram-negative organism type are associated with increased treatment failure. The aim of this research was to determine if specific organisms were associated with poor outcomes in treatment for hip periprosthetic infection. METHODS Records were reviewed of all patients between 2005 and 2015 who underwent treatment for infected partial or total hip arthroplasty. Characteristics of each patient’s treatment course was determined including baseline characteristics, infecting organism(s), infection status at final follow-up, surgeries for infection, and time in hospital. Baseline characteristics and organisms that were associated with clinical outcomes in univariate analysis were incorporated into multivariable outcomes models. RESULTS When compared with patients infected with other organism(s), patients infected with the following organisms had significantly decreased infection-free rates: pseudomonas, methicillin-resistant staphylococcus aureus, and proteus. Infection with certain organisms was associated with 1.13 to 2.58 additional surgeries: methicillin-sensitive staphylococcus aureus, coagulase-negative staphylococcus, MRSA, pseudomonas, peptostreptococcus, klebsiella, candida, diphtheroids, propionibacterium acnes, and proteus species. Specific organisms were associated with 8.56 to 24.54 additional days in hospital for infection: MSSA, CoNS, proteus, MRSA, enterococcus, pseudomonas, klebsiella, beta-hemolytic streptococcus, and diphtheroids. Higher comorbidity score was also associated with greater length of hospitalization. CONCLUSION MRSA, pseudomonas, and proteus were associated with all three outcomes of lower infection-free rate, more surgery, and more time in hospital in treatment for hip periprosthetic infection. Organism-specific outcome information may help individualize patient-physician discussions about the expected course of treatment for hip periprosthetic infection.

➤ Intrawound irrigation is a mainstay in the prevention and treatment of surgical site infections.➤ There are 3 components of irrigation: delivery method, volume, and type of solution (with and without additives).➤ A low-pressure delivery system for a 1 to 9-L volume of solution should be used to irrigate wounds, with a greater volume indicated in the setting of contaminated or infected wounds.➤ Operative irrigation solutions are frequently supplemented with the addition of surfactants, antibiotics, or antiseptics.➤ There is limited evidence with regard to the optimal antiseptic or whether antiseptics confer any advantage. Current literature suggests that surfactants and antibiotics should be avoided.➤ To date, most studies on irrigation solutions in orthopaedics are retrospective, necessitating the organization of prospective randomized controlled trials to guide future evidence-based decisions.