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Jardon M, Fritz J, Samim M. Imaging approach to prosthetic joint infection. Skeletal Radiol 2023:10.1007/s00256-023-04546-7. [PMID: 38133670 DOI: 10.1007/s00256-023-04546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/08/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
The diagnosis of prosthetic joint infection (PJI) remains challenging, despite multiple available laboratory tests for both serum and synovial fluid analysis. The clinical symptoms of PJI are not always characteristic, particularly in the chronic phase, and there is often significant overlap in symptoms with non-infectious forms of arthroplasty failure. Further exacerbating this challenge is lack of a universally accepted definition for PJI, with publications from multiple professional societies citing different diagnostic criteria. While not included in many of the major societies' guidelines for diagnosis of PJI, diagnostic imaging can play an important role in the workup of suspected PJI. In this article, we will review an approach to diagnostic imaging modalities (radiography, ultrasound, CT, MRI) in the workup of suspected PJI, with special attention to the limitations and benefits of each modality. We will also discuss the role that image-guided interventions play in the workup of these patients, through ultrasound and fluoroscopically guided joint aspirations. While there is no standard imaging algorithm that can universally applied to all patients with suspected PJI, we will discuss a general approach to diagnostic imaging and image-guided intervention in this clinical scenario.
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Affiliation(s)
- Meghan Jardon
- Department of Radiology, NYU Langone Medical Center, New York, NY, USA.
| | - Jan Fritz
- Department of Radiology, NYU Langone Medical Center, New York, NY, USA
| | - Mohammad Samim
- Department of Radiology, NYU Langone Medical Center, New York, NY, USA
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2
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Weissman BN, Palestro CJ, Fox MG, Bell AM, Blankenbaker DG, Frick MA, Jawetz ST, Kuo PH, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Total Hip Arthroplasty. J Am Coll Radiol 2023; 20:S413-S432. [PMID: 38040462 DOI: 10.1016/j.jacr.2023.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This article reviews evidence for performing various imaging studies in patients with total hip prostheses. Routine follow-up is generally performed with radiography. Radiographs are also usually the initial imaging modality for patients with symptoms related to the prosthesis. Following acute injury with pain, noncontrast CT may add information to radiographic examination regarding the presence and location of a fracture, component stability, and bone stock. Image-guided joint aspiration, noncontrast MRI, and white blood cell scan and sulfur colloid scan of the hip, are usually appropriate studies for patients suspected of having periprosthetic infection. For evaluation of component loosening, wear, and/or osteolysis, noncontrast CT or MRI are usually appropriate studies. Noncontrast MRI is usually appropriate for identifying adverse reaction to metal debris related to metal-on-metal articulations. For assessing patients after hip arthroplasty, who have trochanteric pain and nondiagnostic radiographs, ultrasound, or MRI are usually appropriate studies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | | | - Angela M Bell
- Rush University Medical Center, Chicago, Illinois; American College of Physicians
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Phillip H Kuo
- University of Arizona, Tucson, Arizona; Commission on Nuclear Medicine and Molecular Imaging
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Probyn L, Flores D, Rowbotham E, Cresswell M, Atinga A. High-resolution ultrasound in the evaluation of the adult hip. J Ultrason 2023; 23:e223-e238. [PMID: 38020511 PMCID: PMC10668929 DOI: 10.15557/jou.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
This paper reviews ultrasound of the hip, which is a commonly requested examination for symptomatic hip issues. This includes both intra-articular and extra-articular causes of hip pain. Ultrasound is easily accessible, lacks radiation exposure, and allows for evaluation of the contralateral hip as well as assessment of dynamic maneuvers. Ultrasound can be used to guide interventional procedures. Ultrasound of the hip can be challenging due to the deep location of structures and complex anatomy. Typically, high-frequency transducers are used to examine the hip, however the choice of ultrasound transducer depends on the patient's body habitus, with lower frequency transducers required to penetrate deep structures in obese patients. It is important to have an approach to ultrasound of the hip which includes assessment of the anterior, lateral, posterior, and medial aspects of the hip. The technique and relevant anatomy of each of these compartments are discussed as well as the use of Doppler examination of the hip. Several dynamic maneuvers can be performed to help determine the cause of hip pathology in various locations, and these are described and illustrated. Ultrasound is useful for guided procedures about the hip, and these indications will be reviewed.
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Affiliation(s)
- Linda Probyn
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Dyan Flores
- Department of Medical Imaging, University of Ottawa, Ottawa, Canada
| | - Emma Rowbotham
- Department of Medical Imaging, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mark Cresswell
- Department of Medical Imaging, University of British Columbia, Vancouver, Canada
| | - Angela Atinga
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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Weaver JS, Omar I, Epstein K, Brown A, Chadwick N, Taljanovic MS. High-resolution ultrasound in the evaluation of musculoskeletal infections. J Ultrason 2023; 23:e272-e284. [PMID: 38020512 PMCID: PMC10668941 DOI: 10.15557/jou.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Soft tissue and osseous musculoskeletal infections are common but can be difficult to diagnose clinically. Signs, symptoms, and physical examination findings may be nonspecific, and laboratory values can be inconclusive. The extent of disease may also be underestimated on physical examination. Soft tissue infections most commonly occur secondary to direct inoculation from broken skin and less frequently due to the seeding of the soft tissues from hematogenous spread, while osseous infections are more commonly due to hematogenous seeding. Infections may also be iatrogenic, following surgery or other procedural interventions. High-resolution ultrasound is an extremely useful imaging modality in the evaluation of musculoskeletal soft tissue and joint infections, and can occasionally be used to evaluate osseous infections as well. Ultrasound can aid in the early diagnosis of musculoskeletal infections, allowing for prompt treatment, decreased risk of complications, and treatment optimization. Ultrasound is sensitive and specific in evaluating soft tissue edema and hyperemia; soft tissue abscesses; joint, bursal and tendon sheath effusions/synovitis; and subperiosteal abscesses. This article describes the typical high-resolution grayscale as well as color and power Doppler ultrasound imaging findings of soft tissue infections including cellulitis, fasciitis, necrotizing deep soft tissue infection, pyomyositis, soft tissue abscess, infectious bursitis, and infectious tenosynovitis. Ultrasound findings of septic arthritis as well as osteomyelitis, such as subperiosteal spread of infection (subperiosteal abscess). are also reviewed. In addition, the use of ultrasound to guide fluid and tissue sampling is discussed.
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Affiliation(s)
- Jennifer S. Weaver
- Department of Radiology, University of Texas Health San Antonio, San Antonio, USA
| | - Imran Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Katherine Epstein
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | | | - Nicholson Chadwick
- Department of Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Mihra S. Taljanovic
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
- Departments of Medical Imaging and Orthopedic Surgery, Banner University Medical Center, Tucson, Arizona, USA
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Macnair R, Rajakulasingam R, Singh S, Khoo M, Upadhyay B, Hargunani R, Pressney I. Image-guided synovial biopsy with a focus on infection. Skeletal Radiol 2023; 52:831-841. [PMID: 36484841 DOI: 10.1007/s00256-022-04245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
Image-guided biopsy of the synovium is a relatively uncommon but safe procedure with a high-diagnostic yield in the correct clinical scenario. Whilst surgical and arthroscopic techniques are still commonly performed and remain the gold standard, they are more invasive, expensive and not widely available. Ultrasound and X-ray-guided synovial biopsy are being increasingly performed by radiologists to diagnose both native and periprosthetic joint infection (PJI) to guide surgical and microbiological management. The purpose of this review article is to present the historical background to synovial biopsy particularly related to potential joint infection, including common and uncommon pathogens encountered, sampling techniques and pitfalls, focusing mainly on its role in PJI and its role in patient pathways and decision-making within a joint infection multi-disciplinary framework.
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Affiliation(s)
- R Macnair
- Department of Radiology, Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, UK
| | - R Rajakulasingam
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
| | - S Singh
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
| | - M Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
| | - B Upadhyay
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
| | - R Hargunani
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.
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Thejeel B, Endo Y. Imaging of total hip arthroplasty: part II – imaging of component dislocation, loosening, infection, and soft tissue injury. Clin Imaging 2022; 92:72-82. [DOI: 10.1016/j.clinimag.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
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Bone and Joint Infections: The Role of Imaging in Tailoring Diagnosis to Improve Patients' Care. J Pers Med 2021; 11:jpm11121317. [PMID: 34945789 PMCID: PMC8709091 DOI: 10.3390/jpm11121317] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
Imaging is needed for the diagnosis of bone and joint infections, determining the severity and extent of disease, planning biopsy, and monitoring the response to treatment. Some radiological features are pathognomonic of bone and joint infections for each modality used. However, imaging diagnosis of these infections is challenging because of several overlaps with non-infectious etiologies. Interventional radiology is generally needed to verify the diagnosis and to identify the microorganism involved in the infectious process through imaging-guided biopsy. This narrative review aims to summarize the radiological features of the commonest orthopedic infections, the indications and the limits of different modalities in the diagnostic strategy as well as to outline recent findings that may facilitate diagnosis.
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Bilgir E, Yıldırım D, Șenturk MF, Orhan H. Clinical and ultrasonographic evaluation of ultrasound-guided single puncture temporomandibular joint arthrocentesis. Cranio 2020:1-10. [PMID: 33267750 DOI: 10.1080/08869634.2020.1853889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effects of successful TMJ treatment on relief of pain, improvement of mandibular movement and capsular width with clinical and ultrasonography (US) findings. In this study, TMJ changes were evaluated by clinical and US examination after US-guided single-puncture arthrocentesis, which represents a novel approach.Methods: Clinical measurements were obtained before each procedure and at 1 day, 7 days, and 3 months thereafter. Capsular width was measured via the US at the 3-month follow-up.Results: Significant improvements were evident at the short term of 3 months post-arthrocentesis with supportive treatment, including splint therapy and jaw exercises.Conclusion: Arthrocentesis in conjunction with splint therapy and jaw exercises demonstrated significant clinical improvement at the short-term follow-up of 3 months. US imaging can be helpful for follow-up evaluation of the pre- and post-treatment capsule width. Longer follow-up studies are necessary to validate the effectiveness of this treatment protocol.
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Affiliation(s)
- Elif Bilgir
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Derya Yıldırım
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
| | - Mehmet Fatih Șenturk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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Sconfienza LM, Signore A, Cassar-Pullicino V, Cataldo MA, Gheysens O, Borens O, Trampuz A, Wörtler K, Petrosillo N, Winkler H, Vanhoenacker FMHM, Jutte PC, Glaudemans AWJM. Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur Radiol 2019; 29:6425-6438. [PMID: 31250170 DOI: 10.1007/s00330-019-06326-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/27/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Peripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement). METHODS AND RESULTS After literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging. CONCLUSIONS Overall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging specialists, costs, and availability. Since robust, comparative studies among most tests do not exist, the proposed flowcharts are based not only on existing literature but also on the opinion of multiple experts involved on these topics. KEY POINTS • For peripheral bone infection and prosthetic joint infection, white blood cell and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities. • Two evidence- and expert-based diagnostic flowcharts involving variable combination of laboratory tests, biopsy methods, and radiological and nuclear medicine imaging modalities are proposed by a multi-society expert panel. • Clinical application of these flowcharts depends on several factors, such as the benefit for the patient, local experience, costs, and availability.
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Alberto Signore
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Victor Cassar-Pullicino
- Department of Diagnostic Imaging, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire, UK
| | - Maria Adriana Cataldo
- Infectious Disease Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Olivier Gheysens
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Borens
- Division of Orthopaedic Surgery and Traumatology, Septic surgical unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Nicola Petrosillo
- Infectious Disease Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Heinz Winkler
- Osteitis-Centre, Privatklinik Döbling, Vienna, Austria
| | - Filip M H M Vanhoenacker
- Department of Radiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium.,AZ Sint-Maarten, Belgium, Mechelen, Belgium.,University of Ghent, Ghent, Belgium
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46:971-988. [PMID: 30683987 PMCID: PMC6450843 DOI: 10.1007/s00259-019-4263-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022]
Abstract
Background For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking. Aim and Methods To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart. Results and Conclusion The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM). Electronic supplementary material The online version of this article (10.1007/s00259-019-4263-9) contains supplementary material, which is available to authorized users.
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Randelli F, Brioschi M, Randelli P, Ambrogi F, Sdao S, Aliprandi A. Fluoroscopy- vs ultrasound-guided aspiration techniques in the management of periprosthetic joint infection: which is the best? Radiol Med 2017; 123:28-35. [PMID: 28932957 DOI: 10.1007/s11547-017-0811-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fluid samples obtained from an affected joint still play a central role in the diagnosis of periprosthetic joint infection (PJI). It is the only preoperative test able to discover the causative microbiological agent. In the hip, fluid aspiration can be performed through fluoroscopy, ultrasound, or, less commonly, computed tomography. However, there is still a lack of consensus on which method is preferable in terms of efficacy and costbenefit. PURPOSES We, therefore, asked whether (1) the benefits in terms of sensitivity and specificity and (2) the costs were comparable between fluoroscopy- and ultrasound-guided joint aspirations in a suspicious of hip PJI. METHODS Between 2013 and 2016, 52 hip aspirations were performed on 49 patients with clinical, radiological, or serological suspicion of PJI, waiting for a revision surgery. The patients were divided in two groups: fluoroscopy- (n = 26) vs ultrasound-guided hip aspiration group (n = 26). These groups were also divided in control and infected patients. The criteria of MusculoSkeletal Infection Society (MSIS) were used, as gold standard, to define PJI. RESULTS (1) Ultrasound-guided aspiration revealed valid sensitivity (89% vs 60%) and specificity (94% vs 81%) in comparison with fluoroscopic-guided aspiration. (2) The cost analysis was also in favor of ultrasound-guided aspiration (125.30€) than fluoroscopic-guided aspiration (343.58€). CONCLUSIONS We concluded that ultrasound-guided hip aspiration could represent a valid, safe, and less expensive diagnostic alternative to fluoroscopic-guided aspiration in hip PJI.
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Affiliation(s)
- Filippo Randelli
- Hip Department, Orthopedics and Trauma V, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy
| | - Marco Brioschi
- Hip Department, Orthopedics and Trauma V, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy. .,Department of Biomedical Sciences for Health, University of Milan, Piazza Malan 2, San. Donato Milanese, 20097, Milan, Italy.
| | - Pietro Randelli
- Department of Biomedical Sciences for Health, University of Milan, Piazza Malan 2, San. Donato Milanese, 20097, Milan, Italy
| | - Federico Ambrogi
- IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San. Donato Milanese, 20097, Milan, Italy
| | - Silvana Sdao
- Radiology Department, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy
| | - Alberto Aliprandi
- Radiology Department, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy
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14
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Abstract
CONTEXT Sports-related injuries of the hip are a common complaint of both competitive and recreational athletes of all ages. The anatomic and biomechanical complexity of the hip region often cause diagnostic uncertainty for the clinicians evaluating these injuries. Therefore, obtaining additional diagnostic information is often crucial for providing injured athletes with a prompt and accurate diagnosis so they can return to activity as soon as possible. Musculoskeletal ultrasound is becoming increasingly important in evaluating and treating sports-related injuries of the hip. EVIDENCE ACQUISITION The PubMed database was searched in May of 2013 for English-language articles pertaining to sonography of sports injuries of the hip using the following keywords in various combinations: musculoskeletal, ultrasound, hip, hip sonography, and sports. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Musculoskeletal ultrasound is currently being used for both diagnosis and treatment in a wide range of acute and chronic conditions affecting the hip, including tendinosis, tendon/muscle strains, ligamentous sprains, enthesopathies, growth plate injuries, fractures, bursitis, effusions, synovitis, labral tears, and snapping hip. Therapeutically, it is used to guide injections, aspirations, and biopsies. CONCLUSION Musculoskeletal ultrasound use is expanding and will likely continue to do so as more clinicians realize its capabilities. Characteristics, including accessibility, portability, noninvasiveness, dynamic examination, power Doppler examination, and low cost highlight the potential of ultrasound.
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Affiliation(s)
| | - Peter H Seidenberg
- Penn State Hershey Bone and Joint Institute, State College, Pennsylvania ; Penn State University, State College, Pennsylvania
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15
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Birn J, Pruente R, Avram R, Eyler W, Mahan M, van Holsbeeck M. Sonographic evaluation of hip joint effusion in osteoarthritis with correlation to radiographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:205-211. [PMID: 24281947 DOI: 10.1002/jcu.22112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 08/13/2013] [Accepted: 09/12/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE Hip joint effusion is expected in rapidly destructive osteoarthritis, a diagnosis often only made retrospectively at the end stage of the disease. This study assesses whether the presence of an effusion identified during routine ultrasound-guided hip injection may suggest a more aggressive process such as rapidly destructive osteoarthritis. METHODS After the observation of 10 index cases of rapidly destructive osteoarthritis in patients who presented with a joint effusion on ultrasound, we retrospectively reviewed 94 hips from 89 patients who underwent ultrasound-guided hip injection for pain. Preinjection longitudinal ultrasound images of the anterior capsule adjacent to the femoral neck and inferior to the femoral head were reviewed to determine if a joint effusion was present and the size of the effusion if one was there. Comparison of effusion size was then made between those hips that had a clinical and radiographic diagnosis of osteoarthritis and those who had rapidly destructive osteoarthritis by comparing the severity of joint effusion, if one was present. RESULTS Patients with rapidly destructive osteoarthritis were more likely to have a large joint effusion 60% (3/5) than were those with osteoarthritis 6.7% (6/89) (p = 0.013). CONCLUSIONS Large joint effusions identified sonographically correlate well with radiographic findings of rapidly destructive osteoarthritis. Given rapid onset and severity of the disease, when a large joint effusion is identified on routine hip intervention, patients should be forewarned of the potential for this disease process.
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Affiliation(s)
- Jeff Birn
- Henry Ford Hospital, Department of Radiology, 2799 West Grand Boulevard, Detroit, MI, 48202
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16
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Yablon CM, Lee KS, Jacobson JA. Musculoskeletal ultrasonography: starting your practice. Semin Roentgenol 2013; 48:167-77. [PMID: 23452464 DOI: 10.1053/j.ro.2012.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109-0326, USA
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17
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Friedman T, Miller TT. MR imaging and ultrasound correlation of hip pathologic conditions. Magn Reson Imaging Clin N Am 2012; 21:183-94. [PMID: 23168191 DOI: 10.1016/j.mric.2012.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance (MR) imaging has become the workhorse in the imaging evaluation of the painful or clinically abnormal hip. It provides an excellent anatomic overview and demonstration of the bony structures, articular surfaces, and surrounding soft tissues. Conversely, sonography can also demonstrate superficial intraarticular structures and the periarticular soft tissues, is quickly performed, allows dynamic evaluation of tendons and muscles, and can guide percutaneous procedures. These two modalities are complementary, and this article concentrates on the MR imaging-sonographic correlations of several entities about the hip.
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Affiliation(s)
- Talia Friedman
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA
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Douis H, Dunlop DJ, Pearson AM, O'Hara JN, James SLJ. The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol 2012; 41:1035-46. [PMID: 22426776 DOI: 10.1007/s00256-012-1390-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/09/2012] [Accepted: 02/26/2012] [Indexed: 02/02/2023]
Abstract
Hip arthroplasty is one of the most commonly performed orthopedic procedures. Clinicians can be faced with the diagnostic dilemma of the patient presenting with a painful hip following arthroplasty and satisfactory post-operative radiographs. Identifying the cause of symptoms can be challenging and ultrasound is increasingly being utilized in the evaluation of potential soft tissue complications following hip surgery. In this article, we describe the common surgical approaches used during hip arthroplasty as this can influence the nature and location of subsequent complications. A review of the literature is presented along with the imaging appearances frequently encountered when imaging this patient population.
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Affiliation(s)
- H Douis
- Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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Royall NA, Farrin E, Bahner DP, Stawicki SP. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop 2012. [PMID: 22474637 DOI: 10.5312/wjo.v2.i7.] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.
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Affiliation(s)
- Nelson A Royall
- Nelson A Royall, David P Bahner, Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Long SS, Surrey D, Nazarian LN. Common sonographic findings in the painful hip after hip arthroplasty. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:301-312. [PMID: 22298875 DOI: 10.7863/jum.2012.31.2.301] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Diagnosing the cause of hip pain in patients with hip arthroplasty can be challenging because of the numerous possible causes of pain and artifacts caused by the prosthetic components on computed tomography and magnetic resonance imaging. Sonography plays an important role in the diagnosis and management of these patients because the soft tissues surrounding the prosthetic joint are not obscured by artifacts and because sonography enables hands-on examination of the painful site, dynamic evaluation of moving structures, and comparison with the opposite side. Another advantage of sonography is the ability to perform sonographically guided diagnostic and therapeutic procedures. In this pictorial essay, we highlight commonly encountered sonographic findings in patients with hip pain after hip arthroplasty.
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Affiliation(s)
- Suzanne S Long
- Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Suite 796C, Philadelphia, PA 19107, USA.
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21
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Royall NA, Farrin E, Bahner DP, Stawicki SP. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop 2011; 2:57-66. [PMID: 22474637 PMCID: PMC3302042 DOI: 10.5312/wjo.v2.i7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 06/28/2011] [Accepted: 07/05/2011] [Indexed: 02/06/2023] Open
Abstract
Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.
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Affiliation(s)
- Nelson A Royall
- Nelson A Royall, David P Bahner, Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH 43210, United States
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22
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Hashefi M. Ultrasound in the Diagnosis of Noninflammatory Musculoskeletal Conditions. Semin Ultrasound CT MR 2011; 32:74-90. [DOI: 10.1053/j.sult.2010.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Johnston C, Kerr J, Ford S, O'byrne J, Eustace S. MRI as a problem-solving tool in unexplained failed total hip replacement following conventional assessment. Skeletal Radiol 2007; 36:955-61. [PMID: 17618430 DOI: 10.1007/s00256-007-0349-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 04/23/2007] [Accepted: 06/01/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate MRI as a problem-solving tool for patients with an unexplained failed total hip replacement following conventional radiological assessment. METHODS AND MATERIALS Patients' informed consent was obtained in all cases. Institutional review board approval was obtained. Twenty-eight patients with unexplained failed total hip replacements following conventional radiological assessment underwent additional MR imaging with an optimised turbo-spin echo sequence. Images were reviewed by two musculoskeletal radiologists by consensus and compared with findings at surgery, or following response to image-guided intervention or clinical follow-up. RESULTS Of the 28 patients, MRI revealed an unsuspected diagnosis explaining the cause of prosthesis failure in 15 patients. In eight of 15 patients in this group, subsequent minimally invasive image-guided intervention obviated the need for revision total hip replacement. No cause for prosthesis failure was identified in 13 patients. DISCUSSION MRI may be successfully undertaken in patients following total hip replacement, and, when performed, it frequently leads to an unsuspected diagnosis, allowing informed patient treatment. In this study it allowed the identification of an unsuspected diagnosis in over 50% of cases.
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Affiliation(s)
- Ciaran Johnston
- Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
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26
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Sofka CM. Current applications of advanced cross-sectional imaging techniques in evaluating the painful arthroplasty. Skeletal Radiol 2007; 36:183-93. [PMID: 17151850 DOI: 10.1007/s00256-006-0226-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 09/10/2006] [Accepted: 09/13/2006] [Indexed: 02/02/2023]
Abstract
Patients with a painful arthroplasty can present a clinical diagnostic dilemma. Aspirates are often negative for infection and alignment of the prosthesis on conventional radiographs is usually satisfactory. These patients can have a myriad of soft tissue as well as osseous pathologies, which may be clinically unsuspected or radiographically occult. The ability of advanced cross-sectional imaging to diagnose osseous and soft tissue injuries has been well documented, but applications to arthroplasty imaging are often limited by regional metallic artifacts. Adjustment of standard imaging parameters can make CT and MR imaging useful adjuncts in imaging the painful arthroplasty, especially in the setting of normal radiographs. Ultrasound can be used to evaluate the periprosthetic soft tissues and provide a real-time method of evaluating the dynamic relationship of the periprosthetic soft tissues to the arthroplasty components, and it also can be used as a guide for diagnostic and therapeutic interventions.
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Affiliation(s)
- Carolyn M Sofka
- Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
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27
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Hoefnagels EM, Obradov M, Reijnierse M, Anderson PG, Swierstra BA. Sonography after total hip replacement: reproducibility and normal values in 47 clinically uncomplicated cases. Acta Orthop 2007; 78:81-5. [PMID: 17453396 DOI: 10.1080/17453670610013457] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Interpretation of sonographic data is difficult when hematoma after total hip replacement is suspected, as there are no normative data. We describe the normal sonographic image, focusing on the amount and location of postoperative fluid collections after a clinically uncomplicated, primary total hip replacement by the posterior approach. Inter- and intraobserver reproducibility is also considered. PATIENTS AND METHODS We performed sonography of the hip in 47 patients between the second and the fifth postoperative day. Bone-to-capsule distance and deep and superficial extraarticular fluid collections were measured. Intraclass correlation coefficients were calculated. RESULTS The normal values of bone-to-capsule distance and amount of extraarticular fluid after total hip replacement were established from the upper bound of the 95% confidence interval. The upper bound for bone-capsule distance was 6 mm, for deep fluid collections 21 mm, and for superficial fluid collections 28 mm. In this clinically normal patient group, 4 patients had an extreme value (< 3 SD) for bone-to-capsule distance. For the deep and superficial fluid collections, no extremes were found. No correlation was found between bone-to-capsule distance and whether or not there was extraarticular fluid. Intraclass correlation coefficients were 0.98 for bone-to-capsule distance and 0.99 for fluid collection measurements. INTERPRETATION Sonography is a reproducible method for the evaluation of fluid collections after total hip replacement. The values measured can be helpful in decision making when there is clinical suspicion of postoperative hematoma after hip replacement by the posterior approach.
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Affiliation(s)
- Eva M Hoefnagels
- Department of Orthopaedics, Sint Maartenskliniek, PO Box 9011, Nijmegen, GM NL-6500, The Netherlands
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Mengiardi B, Pfirrmann CWA, Hodler J. Hip pain in adults: MR imaging appearance of common causes. Eur Radiol 2006; 17:1746-62. [PMID: 17115163 DOI: 10.1007/s00330-006-0491-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 08/25/2006] [Accepted: 09/29/2006] [Indexed: 12/01/2022]
Abstract
To determine the exact origin of hip pain can be challenging. Symptoms apparently originating from the hip may arise from the pelvis, the sacroiliac joint, the lumbar spine, periarticular structures such as muscles and bursae, or from unexpected sites such as the abdominal wall, the genitourinary tract, or the retroperitoneal space. This article reviews the differential diagnosis of hip pain arising from the hip and surrounding structures and the role of different imaging methods with emphasis on magnetic resonance imaging where most recent advances have occurred.
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Affiliation(s)
- Bernard Mengiardi
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.
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Carbó S, Rosón N, Vizcaya S, Escribano F, Zarcero M, Medrano S. Can ultrasound help to define orthopedic surgical complications? Curr Probl Diagn Radiol 2006; 35:75-89. [PMID: 16701119 DOI: 10.1067/j.cpradiol.2006.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article aims to describe and illustrate the usefulness of ultrasound in detecting complications of orthopedic implants, metal fixation devices, and other surgical material, with an emphasis on soft-tissue pathology.
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Affiliation(s)
- Sonia Carbó
- SDI Hospital General de Granollers, Barcelona, Spain.
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31
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Blankenbaker DG, De Smet AA. The Role of Ultrasound in the Evaluation of Sports Injuries of the Lower Extremities. Clin Sports Med 2006; 25:867-97. [PMID: 16962429 DOI: 10.1016/j.csm.2006.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Donna G Blankenbaker
- Division of Musculoskeletal Radiology, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/311 CSC, Madison, WI 53792-3252, USA.
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Abstract
PURPOSE The authors believe that ultrasound as a primary method of image guidance for performing hip aspirations is underutilized, and the authors report their experience in performing ultrasound-guided hip injections in 358 patients, using a free-hand technique. MATERIALS AND METHODS A retrospective review of all adult ultrasound-guided hip injections performed at the authors' institution over a four-year period was performed. RESULTS Retrospective review of an ultrasound database revealed 358 adult hip aspirations/injections were performed at the authors' institution from October 2000-October 2004. All procedures were performed using a longitudinal, anterior approach and without the use of a needle guide. There were no reported cases of inadvertent vascular or femoral nerve puncture. CONCLUSIONS To the authors' knowledge, this is the largest reported series of sonographically-guided adult hip aspirations/injections without the use of a needle guide. The authors believe that ultrasound as a primary method of image guidance for performing hip aspirations is underutilized. The absence of radiation and relatively short procedure time of ultrasound-guided hip injections are favorable factors to both the authors' referring clinician population as well as the patients.
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Affiliation(s)
- Carolyn M Sofka
- Department of Radiology and Imaging Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
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