Retrospective Analysis of the Accuracy of Ultrasound-Guided Magnetic Resonance Arthrogram Injections of the Hip in the Office Setting

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.

Pain After Preoperative Ultrasound Guided Hip Injections for Total Hip Arthroplasty: A Pilot Randomized Controlled Trial

“…In total there were 6 instances of missed injections for 94% accuracy. 26 Furthermore, in a meta-analysis of 4 US-guided (136 hip injections) and 5 landmark-guided (295 hip injections) studies, Hoeber et al reported a weighted mean success rate of 100% for US-guided injections. 27 Multiple potential reasons for the deviation between our injection success rates and previously reported rates exist including injector error, failure of the handheld US device to provide adequate visualization, and differences in ability to detect infiltration into the peri-articular tissue using direct visualization vs. advanced imaging.…”