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Ghandour S, Taseh A, Sussman W, Guss D, Ashkani-Esfahani S, Gupta A, Waryasz G. Case Report: Portable handheld ultrasound facilitates intra-articular injections in articular foot pathologies. FRONTIERS IN PAIN RESEARCH 2024; 5:1254216. [PMID: 38486871 PMCID: PMC10937340 DOI: 10.3389/fpain.2024.1254216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background Intra-articular injections are commonly used to manage joint pathologies, including osteoarthritis. While conventional ultrasound (US) guidance has generally improved intra-articular injection accuracy, forefoot and midfoot joint interventions are still often performed without imaging guidance. This pilot study aims to evaluate the efficacy of office-based, portable ultrasound (P-US) guided intra-articular injections for forefoot and midfoot joint pain caused by various degenerative pathologies. Methods A retrospective analysis was conducted on a series of consecutive patients who underwent P-US guided intra-articular injections following a chief complaint of forefoot or midfoot joint pain. Patients reported their pain levels using the Visual Analog Scale (VAS) pre-injection and at 3 months follow-up. The procedure was performed by an experienced foot and ankle surgeon using a linear array transducer for guidance, and a 25-gauge needle was used to inject a combination of 2 cc 1% lidocaine and 12 cc of Kenalog (40 mg/ml). Complications and pain scores were analyzed using a paired t-test and p < 0.05 was considered significant. Results We included 16 patients, 31% male and 69% female with a mean age (±SD) of 61.31 (±12.04) years. None of the patients experienced immediate complications following the intervention. The mean pre-injection VAS score was significantly reduced from 5.21 (±2.04) to a mean of 0.50 (±1.32) at 3 months follow-up (P < 0.001). Thirteen patients reported complete resolution of pain at the 3-month follow-up. No adverse events were reported throughout the duration of the study. Conclusion This pilot study suggests P-US-guided intra-articular injections offer a safe and effective method for managing forefoot and midfoot joint pain caused by various arthritic pathologies. Further research is warranted to establish the long-term efficacy and comparative effectiveness of P-US-guided injections in larger patient cohorts as compared to non-image guided injections.
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Affiliation(s)
- Samir Ghandour
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Atta Taseh
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Walter Sussman
- Good Samaritan Medical Center, Boston Sports & Biologics PC, Wellesley, MA, United States
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ashim Gupta
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, United States
- Future Biologics, Lawrenceville, GA, United States
- BioIntegrate, Lawrenceville, GA, United States
- Regenerative Orthopaedics, Noida, India
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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2
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Kaufman MW, Nguyen C, Meng Y, Roh E. Posterior intra-articular hip injections: a pilot study investigating a new approach. J Ultrasound 2024:10.1007/s40477-023-00863-8. [PMID: 38311662 DOI: 10.1007/s40477-023-00863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024] Open
Abstract
PURPOSE The purpose of this study was to investigate a novel posterior intra-articular hip injection approach while discussing the clinical pearls for methodology, accuracy, and associated adverse events. The goal was to investigate if this approach could potentially be used in those where the typical anterior access would be challenging. MATERIALS AND METHODS 10 adults (age > 18 years) who were referred to a tertiary outpatient clinic for hip injection due to hip osteoarthritis or femoral acetabular impingement with labral tearing to a single academic sports medicine clinic. Patients were placed in prone position. Posterior structures were identified using a curvilinear transducer. A 22 gauge 3.5-6-inch spinal needle was advanced in-plane to the transducer towards the hip capsule at the head-neck junction of the femur from inferolateral to superomedial. A fluoroscopic arthrogram was obtained to evaluate needle placement accuracy. Location of the needle, direction of contrast flow, the rate of conversion to an anterior portal, and adverse events were analyzed. RESULTS A fluoroscopic arthrogram was obtained after the first attempt in nine patients (90%). One patient (10%) was converted to the anterior approach due to inability to obtain the expected arthrogram. Two patients (20%) demonstrated mild adverse events. CONCLUSION Ultrasound-guided posterior approach hip injection is accurate and without serious adverse events in our study. The posterior approach can be considered as an alternative approach for patients who cannot tolerate or may have technical difficulty with an anterior approach.
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Affiliation(s)
- Matthew W Kaufman
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Avenue, Redwood City, CA, 94063, USA.
| | - Chantal Nguyen
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Avenue, Redwood City, CA, 94063, USA
| | - Yue Meng
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Avenue, Redwood City, CA, 94063, USA
| | - Eugene Roh
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Avenue, Redwood City, CA, 94063, USA
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3
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Angotti ML, Burnett RA, Khalid S, Terhune EB, Della Valle CJ. Intra-articular corticosteroids associated with increased risk of total hip arthroplasty at 5 years. Hip Int 2023; 33:800-805. [PMID: 35722779 DOI: 10.1177/11207000221107225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intra-articular corticosteroid injections are commonly administered for hip pain. However, guidelines are conflicting on their efficacy, particularly in patients without arthritis. This study assessed for an association of corticosteroid injections and the incidence of total hip arthroplasty at 5 years. METHODS Patients with a diagnosis of hip pain without femoroacetabular osteoarthritis who were administered an intra-articular corticosteroid injection of the hip within a 2-year period were identified from the Mariner PearlDiver database. Patient were matched to patients with a diagnosis of hip pain who did not receive an injection. 5-year incidence of total hip arthroplasty was compared between matched patients who received an intra-articular corticosteroid injection and those who did not. RESULTS 2,540,154 patients diagnosed with hip pain without femoroacetabular arthritis were identified. 25,073 (0.9%) patients received a corticosteroid injection and were matched to an equal number of control patients. The incidence of total hip arthroplasty (THA) at 5-year-follow up was significantly higher for the corticosteroid cohort compared to controls (1.1% vs. 0.5%; p < 0.001). The incidence and risk of THA increased along with number of injections (1 injection: 0.8%, OR 1.37; 95% CI, 1.34-1.42; p < 0.001, 2 injections: 1.1%; OR 1.45; CI, 1.40-1.50; p < 0.001, ⩾3 injections: 1.5%; OR 1.48; CI, 1.40-1.56; p < 0.001). CONCLUSIONS There may be a dose-dependent association of corticosteroid injections and a greater risk of total hip arthroplasty at 5 years. These results along with the conflicting guidelines on the efficacy of intra-articular steroids for hip pain should prompt physicians to consider osteoarthritis progression that may occur in the setting of corticosteroid injections in non-arthritic hips.
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Affiliation(s)
| | | | - Syed Khalid
- Midwest Orthopaedics at Rush LLC, Chicago, IL, USA
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4
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Saha P, Smith M, Hasan K. Accuracy of Intraarticular Injections: Blind vs. Image Guided Techniques-A Review of Literature. J Funct Morphol Kinesiol 2023; 8:93. [PMID: 37489306 PMCID: PMC10366715 DOI: 10.3390/jfmk8030093] [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: 05/03/2023] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
Intra-articular injections are widely used for diagnostic and therapeutic purposes of joint pathologies throughout the body. These injections can be performed blind by utilizing anatomical landmarks or with the use of imaging modalities to directly visualize the joint space during injections. This review of the literature aims to comprehensively identify differences in the accuracy of intra-articular injections via palpation vs. image guidance in the most commonly injected joints in the upper and lower extremities. To our knowledge, there are no such comprehensive reviews available. A narrative literature review was performed using PubMed and Google Scholar databases to identify studies focusing on the accuracy of blind or image-guided intra-articular injections for each joint. A total of 75 articles was included in this review, with blind and image-guided strategies being discussed for the most commonly injected joints of the upper and lower extremities. Varying ranges of accuracy with blind and image-guided modalities were found throughout the literature, though an improvement in accuracy was seen in nearly all joints when using image guidance. Differences are pronounced, particularly in deep joints such as the hip or in the small joints such as those in the hand or foot. Image guidance is a useful adjunct for most intra-articular injections, if available. Though there is an increase in accuracy in nearly all joints, minor differences in accuracy seen in large, easily accessed joints, such as the knee, may not warrant image guidance.
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Affiliation(s)
- Prasenjit Saha
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Matthew Smith
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Khalid Hasan
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA
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5
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Holbert SE, Fowler B, West M, Morris J, Turcotte J, King P. Pain After Preoperative Ultrasound Guided Hip Injections for Total Hip Arthroplasty: A Pilot Randomized Controlled Trial. Surg Innov 2022:15533506221124460. [DOI: 10.1177/15533506221124460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Hip replacement is a frequently performed and highly successful treatment for patients with end stage osteoarthritis. Advances in technique and pain management have allowed for rapid mobilization and early discharge after surgery. We hypothesize that pre-incision intra-articular injection of local anesthetic with epinephrine under image guidance combined with post incision peri-articular injection (PAI) may be more effective than PAI alone. Methods. A prospective, randomized, controlled, comparative investigation at a single institution of 41 patients undergoing THA who received standard 30 mL post-arthrotomy, PAI of ropivacaine with epinephrine under direct visualization after prosthesis implantation before closure or an equivalent dose divided into a 10 mL pre-incision, ultrasound guided intra-articular injection and a 20 mL post-arthrotomy PAI. Results. 42 patients were included in this study before its early conclusion with 22 patients in the treatment group and 20 in the control group. There were no significant differences in age, BMI or ASA scores. Additionally, there were no significant differences noted when comparing groups by postoperative outcome measures including OMME, EBL, OR time, PACU minutes, and first and last PACU pain score. Furthermore, there were no significant differences in the PROMs evaluated. Discussion. The addition of ultrasound guided pre-incision intra-articular injection to the standard PAI had no benefit when compared with standard PAI during a THA. Portable mobile phone based ultrasound devices provide a cost effective way to perform musculoskeletal blocks, and further studies on their use and comparative accuracy is warranted. A novel technique for confirmation of injection location is described.
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Affiliation(s)
| | | | | | | | | | - Paul King
- Anne Arundel Medical Center, Annapolis, MD, USA
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6
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Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, Abuhamad A, Noble V, Hussain A, Prosen G, Villen T, Via G, Nogue R, Goodmurphy C, Bastos M, Nace GS, Volpicelli G, Wakefield RJ, Wilson S, Bhagra A, Kim J, Bahner D, Fox C, Riley R, Steinmetz P, Nelson BP, Pellerito J, Nazarian LN, Wilson LB, Ma IWY, Amponsah D, Barron KR, Dversdal RK, Wagner M, Dean AJ, Tierney D, Tsung JW, Nocera P, Pazeli J, Liu R, Price S, Neri L, Piccirillo B, Osman A, Lee V, Naqvi N, Petrovic T, Bornemann P, Valois M, Lanctot JF, Haddad R, Govil D, Hurtado LA, Dinh VA, DePhilip RM, Hoffmann B, Lewiss RE, Parange NA, Nishisaki A, Doniger SJ, Dallas P, Bergman K, Barahona JO, Wortsman X, Smith RS, Sisson CA, Palma J, Mallin M, Ahmed L, Mustafa H. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J 2022; 14:31. [PMID: 35895165 PMCID: PMC9329507 DOI: 10.1186/s13089-022-00279-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
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Affiliation(s)
- Richard A. Hoppmann
- grid.254567.70000 0000 9075 106XInternal Medicine, University of South Carolina School of Medicine, 6311 Garners Ferry Road, Bldg 3, Room 306, Columbia, SC 29209 USA
| | - Jeanette Mladenovic
- grid.414996.70000 0004 5902 8841Foundation for the Advancement of International Medical Education and Research, Philadelphia, USA
| | - Lawrence Melniker
- grid.413734.60000 0000 8499 1112Quality Emergency Department, NewYork-Presbyterian Health System, New York, USA
| | - Radu Badea
- grid.411040.00000 0004 0571 5814Internal Medicine and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Blaivas
- grid.254567.70000 0000 9075 106XInternal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Miguel Montorfano
- grid.414463.00000 0004 0638 1756Ultrasound and Doppler Department, Hospital de Emergencias “Dr. Clemente Alvarez”, Rosario, Argentina
| | - Alfred Abuhamad
- grid.255414.30000 0001 2182 3733Eastern Virginia School of Medicine, Norfolk, USA
| | - Vicki Noble
- grid.443867.a0000 0000 9149 4843Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Arif Hussain
- grid.415254.30000 0004 1790 7311Cardiac Critical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Gregor Prosen
- grid.412415.70000 0001 0685 1285Emergency Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Tomás Villen
- grid.449795.20000 0001 2193 453XFrancisco de Vitoria University School of Medicine, Madrid, Spain
| | - Gabriele Via
- grid.469433.f0000 0004 0514 7845Department of Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ramon Nogue
- grid.15043.330000 0001 2163 1432Emergency Medicine, University of Lleida School of Medicine, Lleida, Spain
| | - Craig Goodmurphy
- grid.240473.60000 0004 0543 9901Ultrasound Education, Penn State College of Medicine, Hershey, USA
| | - Marcus Bastos
- Ultrasound Point of Care, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Juiz de Fora, Brazil
| | - G. Stephen Nace
- grid.267301.10000 0004 0386 9246Medical Education and Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Giovanni Volpicelli
- grid.415081.90000 0004 0493 6869Internal Medicine, Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Richard J. Wakefield
- grid.9909.90000 0004 1936 8403Rheumatology, University of Leeds, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Steve Wilson
- grid.254567.70000 0000 9075 106XUniversity of South Carolina School of Medicine, Columbia, USA
| | - Anjali Bhagra
- grid.66875.3a0000 0004 0459 167XInternal Medicine, Mayo Clinic, Rochester, USA
| | - Jongyeol Kim
- grid.416992.10000 0001 2179 3554Neurology, School of Medicine Texas Tech University Health Sciences Center, Lubbock, USA
| | - David Bahner
- grid.261331.40000 0001 2285 7943Department of Emergency Medicine, The Ohio State University, Columbus, USA
| | - Chris Fox
- grid.266093.80000 0001 0668 7243Department Emergency Medicine, University of California Irvine, Irvine, USA
| | - Ruth Riley
- grid.254567.70000 0000 9075 106XLibrary Services, University of South Carolina School of Medicine, Columbia, USA
| | - Peter Steinmetz
- grid.14709.3b0000 0004 1936 8649Family Medicine, McGill University, Montreal, Canada
| | - Bret P. Nelson
- grid.59734.3c0000 0001 0670 2351Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - John Pellerito
- grid.512756.20000 0004 0370 4759Radiology and Science Education, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, USA
| | - Levon N. Nazarian
- grid.265008.90000 0001 2166 5843Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - L. Britt Wilson
- grid.254567.70000 0000 9075 106XPhysiology, University of South Carolina School of Medicine, Columbia, USA
| | - Irene W. Y. Ma
- grid.22072.350000 0004 1936 7697Medicine, Division of General Internal Medicine, University of Calgary, Calgary, Canada
| | - David Amponsah
- grid.413103.40000 0001 2160 8953Department of Emergency Medicine, Henry Ford Hospital, Detroit, USA
| | - Keith R. Barron
- grid.254567.70000 0000 9075 106XDepartment of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Renee K. Dversdal
- grid.5288.70000 0000 9758 5690Internal Medicine, Oregon Health & Science University, Portland, USA
| | - Mike Wagner
- grid.254567.70000 0000 9075 106XMedicine, University of South Carolina School of Medicine-Greenville, Greenville, USA
| | - Anthony J. Dean
- grid.25879.310000 0004 1936 8972Emeritus Department of Emergency Medicine, Perelman University of Pennsylvania School of Medicine, Philadelphia, USA
| | - David Tierney
- grid.413195.b0000 0000 8795 611XInternal Medicine, Abbott Northwestern Hospital, Minneapolis, USA
| | - James W. Tsung
- grid.59734.3c0000 0001 0670 2351Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paula Nocera
- grid.413471.40000 0000 9080 8521Anesthesiologist, Hospital Sírio Libanês, São Paulo, Brazil
| | - José Pazeli
- Nephology and Critical Care, Barbacena’s School of Medicine, Barbacena, Brazil
| | - Rachel Liu
- grid.47100.320000000419368710Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Susanna Price
- grid.439338.60000 0001 1114 4366Cardiology and Intensive Care, Royal Brompton Hospital, London, England
| | - Luca Neri
- grid.415280.a0000 0004 0402 3867Emergency and Intensive Care Medicine, King Fahad Specialist Hospital Dammam, Ad Dammām, Saudi Arabia
| | - Barbara Piccirillo
- grid.260914.80000 0001 2322 1832New York Institute of Technology, Bellmore, USA
| | - Adi Osman
- Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Raja Permaisuri, Ipoh, Perak Malaysia
| | - Vaughan Lee
- grid.267153.40000 0000 9552 1255Medical Education, University of South Alabama College of Medicine, Mobile, USA
| | - Nitha Naqvi
- grid.420545.20000 0004 0489 3985Royal Brompton Hospital Part of Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | | | - Paul Bornemann
- grid.254567.70000 0000 9075 106XDepartment of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Maxime Valois
- Medicine, McGill and Sherbrooke Universities, Montreal, Canada
| | | | - Robert Haddad
- grid.254567.70000 0000 9075 106XUltrasound Education - Ultrasound Institute, University of South Carolina School of Medicine, Columbia, USA
| | - Deepak Govil
- grid.429252.a0000 0004 1764 4857Critical Care Medicine, Medanta - The Medicity, Gurgaon, India
| | - Laura A. Hurtado
- grid.7345.50000 0001 0056 1981Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Vi Am Dinh
- grid.411390.e0000 0000 9340 4063Emergency Medicine and Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Robert M. DePhilip
- grid.261331.40000 0001 2285 7943Emeritus Biomedical Education and Anatomy, The Ohio State University, Columbus, USA
| | - Beatrice Hoffmann
- grid.38142.3c000000041936754XDepartment of Emergency Medicine, Harvard Medical School, Boston, USA
| | - Resa E. Lewiss
- grid.265008.90000 0001 2166 5843Emergency Medicine and Radiology, Thomas Jefferson University, Philadelphia, USA
| | - Nayana A. Parange
- grid.1026.50000 0000 8994 5086Medical Sonography, University of South Australia Allied Health and Human Performance, Adelaide, Australia
| | - Akira Nishisaki
- grid.25879.310000 0004 1936 8972Anesthesia, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Stephanie J. Doniger
- Pediatric Emergency Medicine, Children’s Hospital in Orange California, Orange, USA
| | - Paul Dallas
- grid.438526.e0000 0001 0694 4940Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Kevin Bergman
- grid.266102.10000 0001 2297 6811Family and Community Medicine, University of California - San Francisco, Martinez, USA
| | - J. Oscar Barahona
- grid.423309.f0000 0000 8901 8514Greenwich Ultrasound Services, Greenwich Ultrasound Associates, PC, Greenwich, USA
| | - Ximena Wortsman
- grid.443909.30000 0004 0385 4466Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - R. Stephen Smith
- grid.15276.370000 0004 1936 8091Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Craig A. Sisson
- grid.267309.90000 0001 0629 5880Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - James Palma
- grid.265436.00000 0001 0421 5525Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | | | - Liju Ahmed
- King Faisal Specialist Hospital and Research Center, Madinah, Kingdom of Saudi Arabia
| | - Hassan Mustafa
- grid.21613.370000 0004 1936 9609Internal Medicine, University of Manitoba, Manitoba, Canada
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8
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Yiannakopoulos C, Sachinis N, Oluku J, Dellis S. Intra-articular Hip Injection Using Anatomical and Radiological Landmarks Without the Use of Ultrasound or Radiological Guidance. Cureus 2022; 14:e23581. [PMID: 35494943 PMCID: PMC9045787 DOI: 10.7759/cureus.23581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/05/2022] Open
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9
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Duck H, Tanner S, Zillmer D, Osmon D, Perry K. Value of ultrasound-guided aspiration of hip arthroplasties performed in an orthopedic clinic by orthopedic surgeons. J Bone Jt Infect 2021; 6:393-403. [PMID: 34804774 PMCID: PMC8600464 DOI: 10.5194/jbji-6-393-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Total joint arthroplasties continue to increase as do periprosthetic joint infections (PJIs). Ultrasound-guided aspiration can yield useful synovial fluid for analysis while avoiding radiation exposure. This study presents a high-yield, ultrasound-guided technique with analysis of aspiration results. Methods: All consecutive ultrasound-guided aspirations of hip arthroplasties performed from May 2016 through to April 2019 were retrospectively reviewed. Patient demographic information, component specifics, presence of draining sinus, and inflammatory markers were recorded. Results of aspiration including volume, appearance, lavage use, synovial fluid differential leukocyte count, synovial neutrophil percent, and culture results were recorded. Surgical results, specimen cultures, and surgeon description of purulence were recorded. Aspiration results were compared to the surgical specimen results in all patients who underwent reoperations. Results: Review of 349 hip aspirations demonstrated accuracy of 87 %, sensitivity of 83 %, specificity of 89 %, positive predictive value of 79 %, and negative predictive value 91 %. Surgical and aspiration cultures matched in 81 % of cases. Bloody aspirates and aspirates obtained after lavage had less accuracy at 69 % and 60 %, respectively. Specificity was 100 % for cultures obtained with lavage and 91 % for bloody aspirates. Synovial leukocyte count and neutrophil percentage was obtained in 85 % of aspirations, and cultures were obtained in 98 % of aspirates. Contamination rate was 2 %. Conclusion: Ultrasound-guided aspirations aid in the diagnosis of PJI. The use of lavage to obtain fluid is helpful when aspiration cultures are positive. Bloody aspirates are less accurate but have high specificity. A low contamination rate and 88 % accuracy results with this meticulous technique.
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Affiliation(s)
- Holly Duck
- Department of Orthopedic Surgery, Mayo Clinic, Rochester MN, USA
| | - Suzanne Tanner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester MN, USA
| | - Debra Zillmer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester MN, USA
| | - Douglas Osmon
- Department of Infectious Diseases, Mayo Clinic, Rochester MN, USA
| | - Kevin Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester MN, USA
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10
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Acetabular labral tears in the adolescent athlete: results of a graduated management protocol from therapy to arthroscopy. J Pediatr Orthop B 2021; 30:549-555. [PMID: 32826727 DOI: 10.1097/bpb.0000000000000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study sought to determine outcomes of a graduated management protocol from therapy to arthroscopy for adolescents presenting with hip pain and an associated acetabular tear. Thirty-seven hips with an MRI confirmed labral tear were prospectively enrolled in a graduated management protocol created for adolescents. The protocol began with activity modification and focused physical therapy. Patients with persistent symptoms were offered an intraarticular corticosteroid injection. Those with continued symptoms were treated with arthroscopic surgery. The modified Harris hip score (mHHS) and nonarthritic hip score (NAHS) were recorded at the initial visit. Patients were contacted by telephone at 1, 2, and 5 years from enrollment for repeat assessment with mHHS and NAHS. At presentation, the mean mHHS and NAHS for the entire cohort was 66.4 ± 11.4 and 70.2 ± 12.6, and these values improved significantly to 89.3 ± 10.6 and 87.0 ± 11.4 at a mean follow-up of 35.7 ± 18.3 months (range 11.7-64.4 months). Forty-two percent of hips were managed with physical therapy and activity modifications alone, 28% of hips progressed to a steroid injection but did not require surgery, and 31% required arthroscopic intervention. Seventy-three percent of hips treated with activity modification alone, 80% treated with an injection, and 82% of hips treated with arthroscopic repair met the minimal clinically significant difference (MCID) (P = 0.859). At an average of 36 months follow-up, the majority (78%) of adolescent patients with an acetabular labral tear will achieve the MCID utilizing a graduated management protocol.
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Maldonado DR, Kyin C, Diulus SC, Shapira J, Rosinsky PJ, Lall AC, Domb BG. Modern Suture Anchor Techniques for Gluteus Medius Tear Repair With Concomitant Total Hip Arthroplasty Using the Direct Anterior and Posterior Approaches. Orthopedics 2021; 44:e653-e660. [PMID: 34590946 DOI: 10.3928/01477447-20210817-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Gluteus medius (GM) tears are currently a well-established source of pain and disability. However, their role in primary total hip arthroplasty (THA) in the setting of osteoarthritis (OA) has been underexamined in the literature. The purpose of this study was to report on short-term patient-reported outcome measurements (PROMs) for patients who underwent concomitant primary THA and GM repair. Data were prospectively collected from September 2011 and June 2017. Inclusion criteria were primary THA along with concomitant GM repair and complete follow-up for the Harris Hip Score, Forgotten Joint Score 12, Veterans RAND 12-item Health Survey both Physical and Mental, 12-item Short Form Survey both Physical and Mental (SF-12 P and SF-12 M), visual analog scale for pain, and patient satisfaction. Patients were excluded if they did not have follow-up. Thirty patients (30 hips) were included. Mean follow-up was 24.2±19.3 months. Twenty-nine (96.7%) patients were female. Mean age was 65.2±7.4 years. Mean body mass index was 31.1±5.9 kg/m2. The posterior approach was used for 16 (53.3%) cases and the anterior approach for the remaining 14 (46.7%). Two (6.7%) patients had a less than 25% tear, 7 (23.3%) had a 25% to 50% tear, 14 (46.7%) had a greater than 50% tear, and 7 (23.3%) had a full-thickness tear. All PROMs except SF-12 M demonstrated significant improvement at latest follow-up. Patients who underwent THA with either the anterior or the posterior approach with concomitant GM repair using modern suture anchor techniques reported favorable PROMs at short-term follow-up. [Orthopedics. 2021;44(5):e653-e660.].
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Trends in Utilization of Image Guidance for Hip Joint Injections. Clin J Sport Med 2021; 31:374-378. [PMID: 32032166 DOI: 10.1097/jsm.0000000000000781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/11/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aims to evaluate trends in utilization of image guidance for intraarticular hip injections and to compare the cost efficiency of ultrasound-, fluoroscopic-, and landmark-guided injections in the management of hip osteoarthritis (OA) and femoroacetabular impingement (FAI). DESIGN Retrospective descriptive epidemiology study. SETTING The information was collected from Humana private payer insurance claims database encompassing all practice settings. PATIENTS OR PARTICIPANTS A total of 302 855 patients for years 2007 to 2015. INTERVENTIONS OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES Primary diagnosis of hip OA or FAI. MAIN OUTCOME MEASURES Injection type [corticosteroid (CS) or hyaluronic acid (HA)], imaging modality (landmark, ultrasound, or fluoroscopic guidance), and costs. RESULTS Landmark-guided CS and HA injections for the management of hip OA decreased, whereas fluoroscopic and ultrasound guidance increased. Similar trends were demonstrated in the management of FAI using CS. In the management of FAI using HA, landmark- and ultrasound-guided injections decreased and fluoroscopic-guided injections increased. Cost analysis revealed lower reimbursement of landmark and ultrasound guidance compared with fluoroscopic guidance. CONCLUSIONS During the study period, there was an increase in the use of image guidance and decline in landmark guidance for the treatment of OA and FAI using CS and HA. Fluoroscopic guidance demonstrated increased reimbursement compared with landmark and fluoroscopic guidance. There is an opportunity to mitigate cost and reduce radiation exposure by using ultrasound-guided injections rather than fluoroscopic guidance.
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Varady NH, Amen TB, Abraham PF, Chopra A, Freccero DM, Smith EL, Martin SD. Image-Guided Intra-articular Hip Injections and Risk of Infection After Hip Arthroscopy. Am J Sports Med 2021; 49:2482-2488. [PMID: 34161174 DOI: 10.1177/03635465211022798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although intra-articular injections are important in the management of patients who may later undergo hip arthroscopy, conflicting data are available regarding the safety of such injections when administered within 3 months of surgery. Furthermore, despite the increasing use of image-guided intra-articular hip injections, it is unknown whether the type of imaging modality used is associated with infection after hip arthroscopy. PURPOSE To assess the risk of infection associated with image-guided intra-articular injections before hip arthroscopy and, secondarily, compare that risk between ultrasound (US) and fluoroscopic (FL) guidance. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This was a retrospective cohort study of patients in a large national insurance database who underwent hip arthroscopy between 2007 and 2017. Patients were required to have continuous enrollment from at least 1 year before to 6 months after hip arthroscopy. Patient age, sex, geographic region, medical history, surgical details, and hip injections were collected. Patients who underwent injection ≤3 months preoperatively and >3 to ≤12 months preoperatively were compared with patients who did not undergo preoperative injection. Bivariate analyses and multivariable logistic regressions were used to assess the association between ipsilateral preoperative hip injection and surgical site infection within 6 months of surgery. RESULTS We identified 17,987 patients (36.3% female; mean ± SD age, 37.6 ± 14.0 years) undergoing hip arthroscopy, 2276 (12.7%) of whom had an image-guided hip injection in the year preceding surgery (53.0% FL). Patients who underwent intra-articular injection ≤3 months preoperatively had similar infection rates to patients who did not undergo preoperative injection in the year before surgery for both the FL (0.46% vs 0.46%; P≥ .995) and the US cohorts (0.50% vs 0.46%; P = .76). Results persisted in adjusted analysis (FL ≤3 months: OR, 1.04; 95% CI, 0.32-3.37; P = .94; US ≤3 months: OR, 1.19; 95% CI, 0.36-3.90; P = .78). Similar results were seen for patients undergoing injections >3 to ≤12 months preoperatively. CONCLUSION Postoperative infection was rare in patients undergoing intra-articular hip injection ≤3 months before hip arthroscopy and was no more common than in patients not undergoing preoperative injection. Moreover, no differences were seen in infection risk between US and FL guidance. Although intra-articular hip injections should always be administered with careful consideration, these results do not suggest that these injections are uniformly contraindicated in the 3 months preceding hip arthroscopy.
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Affiliation(s)
- Nathan H Varady
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Paul F Abraham
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Ahab Chopra
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - David M Freccero
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Eric L Smith
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts, USA
| | - Scott D Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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O'Rourke N. The orthopaedic nurse practitioner: Breaking tradition to fill gaps in care delivery through varied scopes of practice. Int J Orthop Trauma Nurs 2021; 44:100843. [PMID: 33478826 DOI: 10.1016/j.ijotn.2020.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/29/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Musculoskeletal conditions are the world's fourth largest burden of disease, accounting for more than 50% of chronic health conditions in the population aged >50 years (Briggs et al., 2016). This increasing burden is due to a progressively overweight, sedentary and ageing population and is often poorly recognised as a priority globally in an under-resourced health care system. This article reviews the current literature to identify where Orthopaedic Nurse Practitioners (ONPs) currently fill gaps in care delivery through varied scopes of practice in musculoskeletal trauma, degenerative disease, tumour and bone health. The varied scopes of practice include, fracture management, surgical assisting, performing surgical and/or advanced clinical procedures, prescribing treatment for bone health, conducting home visits and managing ONP led outpatient clinics. The article will outline current ONP roles in orthopaedic trauma, pain management, fragility hip fractures, osteoporosis, bone and soft tissue sarcoma and surgical assisting which effectively address long waiting lists, gaps in care delivery and reduce costs currently being managed by the health care system. METHOD A brief search of the literature published from January 2008-January 2020 on CINAHL, Cochrane Library, MEDLINE, Joanna Briggs Institute, Ovid, PubMed, Embase and Pro Quest databases was undertaken using key words Orthopaedic Nurse Practitioner, Advanced Practice Nurse (APN), musculoskeletal health, bone health, nurse-led and nurse specialist. CONCLUSION ONPs offer an innovative, viable and cost-effective solution to providing comparable, effective and efficient care with varied scopes of practice and valuable experience in both the inpatient and outpatient settings.
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Maldonado DR, Diulus SC, Meghpara MB, Glein RM, Ankem HK, Lall AC, Domb BG. Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach. Arthrosc Tech 2021; 10:e575-e580. [PMID: 33680795 PMCID: PMC7917340 DOI: 10.1016/j.eats.2020.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Gluteus medius (GM) tears are a well-established source of pain and disability. Considering previous studies, which have reported rates of incidental GM tears in 20% of patients undergoing primary total hip arthroplasty (THA) and a 3-fold greater rate in elderly female patients, additional focus should be placed on identifying treatment options. The direct anterior approach (DAA) for primary THA has gained popularity within the past few years. However, there has been a paucity in the literature on how to address symptomatic and partial GM tears through this approach. The purpose of this Technical Note is to describe a method to repair partial GM tears during primary THA using the DAA.
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Affiliation(s)
| | | | - Mitchell B. Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Rachel M. Glein
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Hari K. Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ajay C. Lall
- American Hip Institute, Chicago, Illinois, U.S.A.,American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G. Domb
- American Hip Institute, Chicago, Illinois, U.S.A.,American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.,Address correspondence to Dr. Benjamin G. Domb, 999 M.D., E Touhy Ave., Suite 450, Des Plaines, IL 60018.
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Current Variation in Joint Aspiration Practice for the Evaluation of Pediatric Septic Arthritis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00133. [PMID: 32890012 PMCID: PMC7469993 DOI: 10.5435/jaaosglobal-d-20-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pediatric septic arthritis (SA) is a condition that can be associated with significant morbidity. Although previous research has been on predictive care pathways, scrutiny of the literature continues to reveal wide differences in the patient evaluation and management. The purpose of this study was to define the differences in joint aspiration for the evaluation of pediatric SA across pediatric tertiary care institutions in the United States.
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Mortazavi SJ, Nabian MH. Point-of-Care Ultrasonography in Orthopedics: A Helpful Tool to Improve Patient Care. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:323-324. [PMID: 32766388 DOI: 10.22038/abjs.2020.47207.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sm Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Lee BJ, Moon H, Hwang JM, Park D. An Alternative Approach to the Ultrasound-Guided Intra-Articular Hip Injection. PM R 2019; 12:104-106. [PMID: 31677245 DOI: 10.1002/pmrj.12277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/31/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Byung Joo Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Hyunseok Moon
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Jong Moon Hwang
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea
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Walter WR, Bearison C, Slover JD, Gold HT, Gyftopoulos S. Clinical and patient-reported outcomes after image-guided intra-articular therapeutic hip injections for osteoarthritis-related hip pain: a retrospective study. Skeletal Radiol 2019; 48:713-719. [PMID: 30415421 DOI: 10.1007/s00256-018-3113-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate change in patient-reported outcomes following image-guided intra-articular therapeutic steroid hip injections for pain and assess correlations of outcomes with patient- and injection-specific factors. MATERIALS AND METHODS We retrospectively reviewed consecutive patients treated for hip pain who completed outcomes assessments from October 2011 to September 2017 at an outpatient orthopedic surgery clinic. Only patients with radiographic hip osteoarthritis (Tönnis grade ≥ 1) who underwent steroid hip injections were included. Outcomes assessments included EuroQol-5 domain (EQ5D), EQ5D-visual analog scale (VAS), and hip disability and osteoarthritis outcome score (HOOS), obtained before and within 1-6 months post-injection. Among 113 patients who completed surveys, the mean age was 59 years (±13.7 years), including 77 women (68%) and 36 men (32%). Time to repeat injection or arthroplasty was recorded. Exact Wilcoxon signed rank test assessed score differences and Spearman correlation, Kruskal-Wallis, and Mann-Whitney tests assessed correlations. RESULTS Of 113 patients, 34 had outcomes measured at <8 weeks and 79 at ≥8 weeks. There was no significant change among any of the patients, short- or long-term follow-up subgroups in EQ5D (p = 0.450, 0.770, 0.493 respectively), EQ5D-VAS (p = 0.581, 0.915, 0.455), average-HOOS (p = 0.478, 0.696, 0.443) or total-HOOS (p = 0.380, 0.517, 0.423) scores. Forty-nine patients underwent hip arthroplasty within 1 year. Positive correlation was found between days from injection to surgery and change in EQ5D (r = 0.29, p = 0.025), average-HOOS (r = 0.33, p = 0.019), and total-HOOS (r = 0.37, p = 0.008). CONCLUSION We demonstrated no significant change in patient-reported outcomes measured at short- and long-term intervals up to 6 months after therapeutic steroid hip injections.
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Affiliation(s)
- William R Walter
- Department of Radiology, Musculoskeletal Division, NYU Langone Health, 301 E. 17th Street, 6th Floor, New York, NY, 10003, USA.
| | - Craig Bearison
- Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Heather T Gold
- Department of Orthopedic Surgery and Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Soterios Gyftopoulos
- Department of Radiology, Musculoskeletal Division, NYU Langone Health, New York, NY, USA
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Commentaries on health services research. JAAPA 2018. [DOI: 10.1097/01.jaa.0000546482.10184.2f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kraeutler MJ, Garabekyan T, Fioravanti MJ, Young DA, Mei-Dan O. Efficacy of a non-image-guided diagnostic hip injection in patients with clinical and radiographic evidence of intra-articular hip pathology. J Hip Preserv Surg 2018; 5:220-225. [PMID: 30393548 PMCID: PMC6206695 DOI: 10.1093/jhps/hny013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/09/2018] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to determine the likelihood of pain relief, as a measure of accurate diagnosis of intra-articular hip pathology and correct needle placement, with a non-image-guided intra-articular hip injection performed bedside in the clinic. A retrospective study of prospectively collected data was performed in a consecutive cohort of patients diagnosed with symptomatic intra-articular hip pathology who underwent a non-image-guided intra-articular injection in the clinic. All patients had clinical and radiographic evidence of hip impingement, hip instability, chondrolabral pathology, or other causes of intra-articular hip pain. A previously described technique for a non-image-guided hip injection was performed using 7-10 ml of 1% lidocaine for diagnostic evaluation with some patients receiving 2 ml of Kenalog®-40 if clinically indicated. Ten minutes following each injection, the patient was asked to report the percent improvement in pain (from 0 to 100%) while physical examination and provocative tests were repeated. The final study cohort comprised 142 patients (161 injections). In three cases, patients were either unable to assess or quantify any change in pain level 10 min following the injection. In the remaining 158 hip injections, pain relief was noted in 156 cases (156/158, 98.7%), with at least 70% improvement in pain level noted in 152 cases (152/158, 96.2%). Average pain relief among all 158 injections was 89 ± 16%. A non-image-guided diagnostic intra-articular hip injection yields reliable short-term pain relief, simultaneously endorsing accurate diagnosis of hip pathology and intra-articular needle placement.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopaedic Surgery, Seton Hall-Hackensack Meridian School of Medicine, South Orange, NJ, USA
| | | | - Matthew J Fioravanti
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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Jernick M, Walker Gallego E, Nuzzo M. Retrospective Analysis of the Accuracy of Ultrasound-Guided Magnetic Resonance Arthrogram Injections of the Hip in the Office Setting. Orthop J Sports Med 2017; 5:2325967117743915. [PMID: 29270441 PMCID: PMC5731629 DOI: 10.1177/2325967117743915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Ultrasound (US)–guided intra-articular hip injections have been proposed in the literature to be accurate, reliable, and safe alternatives to fluoroscopy-guided injections. Purpose: To evaluate the accuracy of US-guided magnetic resonance (MR) arthrogram injections of the hip performed in the office setting by a single orthopaedic surgeon and elucidate the potential effects that patient age, sex, and body mass index (BMI) have on contrast placement. Study Design: Case series; Level of evidence, 4. Methods: From a review of the senior author’s office database, 89 patients (101 hips) who had US-guided MR arthrogram injections performed between December 2014 and June 2016 were identified. Official radiology reports were evaluated to determine whether extra-articular contrast was noted. Patient variables, including BMI, age, and sex, were evaluated between patients who had inappropriately placed contrast and those who did not. Results: Of the 101 hip injections, there were 6 cases that demonstrated inadequate contrast placement within the joint, likely secondary to extravasation or incorrect placement; however, an MR arthrogram was adequately interpreted in all cases. There were no significant differences noted between those with appropriate versus inappropriate contrast placement when evaluating BMI (P = .57), age (P = .33), or sex (P = .67), and neither group had an adverse event. Conclusion: US-guided injections are safe and accurate alternatives to fluoroscopy-guided injections in the office setting, with 94% accuracy. Furthermore, BMI, age, and sex did not play a statistically significant role among patients with inappropriately placed contrast.
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Affiliation(s)
- Michael Jernick
- University of California, San Francisco-Fresno, Fresno, California, USA
| | - Edward Walker Gallego
- University of California, San Francisco-Fresno, Fresno, California, USA.,Houston Methodist Outpatient Center, Houston, Texas, USA
| | - Michael Nuzzo
- University of California, San Francisco-Fresno, Fresno, California, USA.,Sierra Pacific Orthopedics, Fresno, California, USA
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