Hip Injections: Can Ultrasound Compete With Fluoroscopy?
Hip Injections: Can UltrasoundCompete with Fluoroscopy?Soumo De, MD, sde@kumc.eduKamran Ali, MD, kamrad9898@yahoo.comUniversity of Kansas-WichitaCategory: Scientific ArticleAbstract Number: SP 027
Disclosures No relevant author disclosures.
Introduction Common reasons for joint injections:– Contrast injection prior to magnetic resonanceimaging arthrograms– Verifying position prior to steroid injection andjoint aspiration.
Ultrasound and fluoroscopic guidance are twoapproach methods. Past comparisons evaluated factors includingpain and outcome after steroid injection.
Hypothesis The technical success rate between ultrasoundand fluoroscopy have an equivalent successrate between the procedures.
Method We reviewed 31 adult ultrasound guided hipinjections and 26 adult fluoroscopic guidedhip injections at our institution from 2012 to2016 for a total of 57 hip injections. Procedures were performed either by anattending or a resident with attendingsupervision.
Injection success was determined by thepresence of intra-articular contrast material asseen on ultrasound and fluoroscopic imaging. Mixed or extra-articular contrast wasconsidered suboptimal. Fluoroscopic time wasalso recorded.
Fluoroscopic injectionProcedure at our Institution: Fluoroscopic images duringintra-articular injection of contrast in the hip joint.
Ultrasound Guided InjectionProcedure at our institution:Top left and right images showtransverse and longitudinalneedle positioning in the joint,respectively.Bottom left image showsinjected fluid in the joint.
Results FluoroscopySuccessful %Fluoroscopic GuidedProceduresSuboptimal %8119 Suboptimal injections were mixed intra- andextra-articular injections. 0% unsuccessful procedures. Average fluoroscopic time was 82 seconds.
Results UltrasoundSuccessful %Ultrasound GuidedProcedures Suboptimal injectionsSuboptimal %7723– 3 patients with mixed intra- and extra-articularinjections.– 2 patients with extra-articular injection.– 1 patient with no contrast injection due to patientdiscomfort.– 1 patient with inadequate visualization of the hip joint.
Discussion Our comparison demonstrated a slightlyhigher success rate with fluoroscopic guidancecompared to ultrasound guidance. This could be attributed to easier visualizationof the joint and landmarks under fluoroscopy. Operator technique and experience may alsobe a contributing factor.
Success rate of fluoroscopy is tempered by theexposure of patients and healthcare staff toradiation. Ultrasound guided procedures demonstrateda comparable success rate compared tofluoroscopic guidance. Ultrasound benefits include non-ionizingradiation. Patient stratification by body habitus couldreveal higher success rates in smaller patients.
References Byrd, JW, et al. “Ultrasound-guided hipinjections: a comparative study withfluoroscopy-guided injections.” Arthroscopy.2014 Jan 30. 42-6. Finnoff, J, et al. “Accuracy of UltrasoundGuided Versus Fluoroscopically GuidedContrast-Controlled Piriformis Injections.”Journal of Ultrasound Medicine. Aug 1, 2008.27 - 8.
Results Ultrasound Suboptimal injections - 3 patients with mixed intra- and extra-articular injections. - 2 patients with extra-articular injection. - 1 patient with no contrast injection due to patient discomfort. - 1 patient with inadequate visualization of the hip joint. 77 23 Ultrasound Guided Procedures Successful % Suboptimal %
Three-dimensional ultrasound, may be acquired and displayed over time. This is variously known as 4D ultrasound, real-time 3D ultrasound, and live 3D ultrasound. When used in conjunction with 2D ultrasound, 3D ultrasound has added diagnostic and clinical value for select indications and circumstances in obstetric and gynecologic ultrasound.
ultrasound injection, whereas 1 was uncertain. The injection was successful in 202 of the first 206 patients (98%) to undergo ultrasound injection, whereas 4 patients required a second pass for a successful injection. Discussion Our data clearly show that ultrasound-guided office-based intra-articular injection of the hip is an effective
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hip for this explanation of total hip replacement. There can be other reasons for the re-placement, but, in general, the hip replacement method will be similar. To understand a total hip replacement, you must first understand the structure of the hip joint. The hip joint is a ball-and-socket
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