Arthrography
Home Materials Radiography Arthrography CT and MRI References

 

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Fixation
Prosthesis Types
 Total Hip 
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Radiography
Baseline Exam
 Alignment
 -Acetab. Position
 -Inclination
 -Anteversion
 -Center of Rotation
 -Femoral Stem 
 -Leg Length Discr.
 Intra-op- Fractures 
 Cement Herniation
Follow-up Study
 Bony Abnormalities
 Fracture
 Heterotopic Bone
 Non Union
 Hardware Failure
 -Polyethylene Wear
 -Dislocation
 Osteolysis
 Loosening
 Infection
Arthrography
CT and MRI
References

Arthrography

  • Most frequently used for the evaluation of infection
  • Confirms intra-articular position of needle
  • Demonstrates abscess cavities, bursae, and sinus tracts
  • Sensitivity for infection: 66-90%(Dussault, Teranzedeh)
  • Limited sensitivity for loosening
  • Done under fluoroscopic guidance
  • Surgical scar examined for areas of leakage or dehiscence
  • Femoral artery palpated and marked
  • Needle entry site lateral to femoral artery, at level of groin crease, orthogonal to neck of prosthesis
  • Needle advanced to metal
  • Standard sterile technique
  • 20 gauge spinal needle
  • Needle is felt striking metal. Attempt is made to place needle at edge of prosthesis, so the tip can be as inferior as possible, where more fluid collects.
  • Joint fluid aspirated and sent for gram stain, aerobic and anaerobic cultures and sensitivities, cell count and differential, labeled hip aspirate. Fungal and AFB cultures sent if needed.
  • Arthrogram performed with sequential digital subtracted spot films, 1 every 2 seconds, during contrast injection.
  • Contrast aspirated and sent for cultures labeled hip wash.

Femoral artery marked. Forceps at area of planned needle insertion

Sterile prep and drape

ARTHROGRAPHY

Needle advanced to metal

Aspiration of joint fluid

Aerobic and anaerobic culture tubes

Normal arthrogram


Dry tap

DDx:

  • Dry joint
  • Large periarticular bursa acting as sump for fluid
  • Sinus track allowing for continuous drainage of joint
  • Non bacteriostatic saline wash performed

Dry tap secondary to large greater trochanteric bursa, 20 gauge spinal needle placed in bursa under fluoroscopic guidance


 

Scar with focal area of drainage. Dry tap secondary to large greater trochanteric bursa with sinus tract draining to skin


Dry tap secondary to sinus tract decompression


Dry tap secondary to sinus tract decompression


Sinus tract draining posteriorly


Arthrographic evidence of loosening—contrast enters abnormally widened interface Gruen zone 1 and 2


Arthrographic evidence of cup loosening—contrast enters abnormally widened interface Gruen zone II and III


Aspiration of hip after removal of prosthesis. Needle placed at femoral edge where fluid collects. Needle should not be placed in acetabular area, which may not be fully intact, risking needle entry into pelvic cavity.


 

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