Ultrasound and Ultrasound-Guided Hip Injection Have High Accuracy in the Diagnosis of Femoroacetabular Impingement With Atypical Symptoms

Gao, Guanying; Fu, Qiang; Wu, Ruiqi; Liu, Rongge; Cui, Ligang; Xu, Yan

doi:10.1016/j.arthro.2020.08.013

Cited by 34 publications

(38 citation statements)

References 29 publications

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“…The most important finding of this study was the lack of association between preoperative image-guided intra-articular injections and infection after hip arthroscopy. Given that hip injections are central to diagnosing labral and other intra-articular hip pathologies, 9,13,30 it is not uncommon for a hip injection to be administered in the months preceding hip arthroscopy. The present study population highlights this practice, as the majority of all patients who received injection underwent arthroscopy within 3 months of injection.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, the decision about which image guidance method to use should likely be made on the basis of other factors, such as provider experience, patient-reported outcomes and satisfaction, radiographic accuracy, and resource availability. 1,2,4,5,13,18,21,22…”

Section: Discussionmentioning

confidence: 99%

“…In addition to differing data sources, an important distinction between these works was the use of image guidance; Wang et al did not evaluate this factor (or include the Current Procedural Terminology [CPT] code for ultrasound [US]-guided injections), 15 and Byrd et al 4 included only US-guided injections. In fact, despite the increasing use of US-guided hip injections 17,21 (supported by studies on radiographic accuracy 2,13,18,21 and patient-reported outcomes 1,5,22 ), to our knowledge no previous study has compared the risk of complications, including infection, between US- and fluoroscopy (FL)-guided hip injections before hip surgery. If preoperative injections do pose an infection risk, then differences in instrumentation, materials, and technique between US- and FL-guided injections could lead to differences in infection rates between modalities.…”

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confidence: 99%

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Image-Guided Intra-articular Hip Injections and Risk of Infection After Hip Arthroscopy

et al. 2021

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Image-Guided Intra-articular Hip Injections and Risk of Infection After Hip Arthroscopy

et al. 2021

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“…U ltrasound (US) has gained increased attention as an injection guidance and diagnostic tool for musculoskeletal pathologies. [1][2][3][4][5][6][7][8] In comparison to magnetic resonance imaging (MRI), computerized tomography (CT), and plain radiographs, US is clearly in its infancy with regard to widespread use and ability to interpret results. In addition, the literature is fairly limited in comparison to other imaging modalities for musculoskeletal pathology.…”

Section: See Related Article On Page 128mentioning

confidence: 99%

Editorial Commentary: Ultrasound-Guided Injection With Dynamic Assessment Could Improve Outcomes in Atypical and Revision Hip Arthroscopy Patients: But Today, Few Are Trained to Hear at Such High Frequencies

Larson¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Imaging modalities for hip disorders all have their strengths and weaknesses. Magnetic resonance imaging is superior for evaluating soft tissue pathology, computerized tomography best characterizes osseous morphology, and plain radiographs can accurately depict 2-dimensional anatomy and are familiar to most clinicians. Ultrasound-guided injections have become commonplace in the musculoskeletal arena. Ultrasound evaluation of musculoskeletal anatomy has received increased attention, has the ability to image soft tissue and osseous structures, and more importantly, has the ability to dynamically evaluate these structures in real time. A noninvasive dynamic assessment of the hip region could be an absolute game changer for the hip preservation/sports medicine community in the diagnosis of atypical hip pain, femoroacetabular impingement, and labral tears. Widespread ability and expertise to perform these dynamic ultrasound assessments, however, is not in place at this time. We need more training and studies to best harness the potential benefits of these sound waves.

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“…All patients underwent a thorough and systematic physical examination, including speci c tests previously described for diagnosing hip diseases. [19] Flexion, adduction, and internal rotation (FADIR) or exion abduction external rotation (FABER) tests are considered positive if hip or groin pain was elicited when the hip was placed in 90° of exion and then adduction and internal rotation or exion, abduction and external rotation applied. [20] Supine anteroposterior hip radiographs, cross-table lateral radiographs, CT images, and MR images were obtained for all patients preoperatively (Figure 1, 2).…”

Section: Physical Examination and Radiographic Assessmentmentioning

confidence: 99%

Hip Arthroscopy has Good Clinical Outcomes in the Treatment of Osteoid Osteoma of the Acetabulum

Gao

Liu

et al. 2021

Preprint

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Background: Osteoid osteoma (OO) of the acetabulum is a relatively rare disease. The clinical outcomes of hip arthroscopy for treatment of OO of the acetabulum is still uncertain.Methods: We evaluated consecutive patients who were diagnosed with OO of the acetabulum and underwent hip arthroscopy for treatment in our hospital between January 2013 and March 2020. All patients underwent preoperative physical examination. Preoperative supine anteroposterior hip radiographs, cross-table lateral radiographs, CT images, and MR images were obtained for all patients. Alpha angle and lateral center-edge angle were measured before surgery. Supine anteroposterior hip radiographs and CT images were obtained for all patients postoperatively. Preoperative patient-reported outcomes (PROs), including visual analog scale (VAS), the International Hip Outcome Tool-12 (iHOT-12) and modified Harris Hip Score (mHHS), and PROs at final follow-up were evaluated.Results: A total of 6 patients (mean age, 18.7 years; age range, 6-31 years; 5 males and 1 females) were included in this study. The average follow-up period after surgery was 28.3 months (range, 6–90 months). Before surgery, mean mHHS was 45.2±10.5 (range, 33-56), mean iHOT-12 was 33.3±14.5 (range, 13-49), and mean VAS was 8.2±1.0 (range, 7-9). At one month after surgery, mean mHHS was 78.7±1.9 (range, 77-81), iHOT-12 was 71.0±4.5 (range, 68-80), and mean VAS was 0. At the final post-operative follow-up, mean mHHS was 89.2±2.1 (range, 86-91), iHOT-12 was 93.5±5.0 (range, 88-98), and mean VAS was 0. All results, except VAS between one month after surgery and at final follow-up, demonstrated statistically significant improvement (P < 0.05). One patient underwent revision surgery.Conclusion: Hip arthroscopy has good clinical outcomes in the treatment of OO of the acetabulum.

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Ultrasound and Ultrasound-Guided Hip Injection Have High Accuracy in the Diagnosis of Femoroacetabular Impingement With Atypical Symptoms

Cited by 34 publications

References 29 publications

Image-Guided Intra-articular Hip Injections and Risk of Infection After Hip Arthroscopy

Image-Guided Intra-articular Hip Injections and Risk of Infection After Hip Arthroscopy

Editorial Commentary: Ultrasound-Guided Injection With Dynamic Assessment Could Improve Outcomes in Atypical and Revision Hip Arthroscopy Patients: But Today, Few Are Trained to Hear at Such High Frequencies

Hip Arthroscopy has Good Clinical Outcomes in the Treatment of Osteoid Osteoma of the Acetabulum

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