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Arthrography after total hip arthroplasty: utility of postambulation radiographs.
We compare pre- and postambulation arthrograms in 24 patients with total hip arthroplasty. In nearly half (42%) of these cases, the arthrographic evidence of a loosened prosthesis was more obvious after ambulation. Three patients (12.5%) had components which were normal by arthrographic criteria before walking, but were abnormal afterwards. We conclude that postambulation radiographs are valuable in patients who are examined for suspected loosening of prosthetic components.
[Arthrography of the knee joint; technic, experiences, results and indication].
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Noncontrast MR imaging and MR arthrography of the ulnar collateral ligament of the elbow: prospective evaluation of two-dimensional pulse sequences for detection of complete tears.
OBJECTIVE: To compare MR imaging techniques with differing contrast and spatial resolution for evaluation of complete disruption of the ulnar collateral ligament (UCL) anterior bundle in a cadaveric elbow model. DESIGN: Complete UCL tears were surgically created at the typical location for clinical tears in eight of 28 fresh frozen cadaveric elbow specimens. All specimens underwent 1.5 T MR imaging in the oblique coronal plane, using an extremity coil. The sequences employed were: T1-weighted spin echo (T1 SE), proton density-weighted (PD) fast spin echo (FSE), fat-suppressed T2-weighted FSE (T2 FSE), gradient recalled echo (GRE) with a high matrix, PD FSE with a high matrix (HRPD), and fat suppressed T1-weighted SE with intra-articular gadolinium (MRAr). Two radiologists independently graded the UCL with separate and side-by-side assessments. RESULTS: Sensitivity/specificity pairs were as follows for reader A and reader B, respectively: T1 SE: 0.25/0.95, 0.50/0.95; PD FSE: 0.38/1.00, 0.25/1.00; T2 FSE: 0.50/0.95, 0.63/0.95; GRE: 0.63/0.85, 0.63/0.60; MRAr: 0.88/1.00, 1.00/0.80; HRPD: 0.50/1.00, 0.88/0.80. Kappa statistics for measuring interobserver reliability for each sequence were poor under T1 SE (-0.13) and GRE (0.19), moderate under HRPD (0.41) and T2 FSE (0.44) and good under MRAr (0.62) and PD FSE (0.78). For both readers, the rating for overall image quality was highest for HRPD, and the rating for UCL lesion conspicuity was the highest for MRAr. CONCLUSIONS: Of the MR imaging pulse sequences tested, MRAr showed the greatest ability to identify complete ligamentous injuries with good agreement between readers and had the highest subjective preference for lesion conspicuity. However, HRPD had the least interobserver variability and the highest subjective preference for overall image quality.
Arthrography of the shoulder as a diagnostic aid in tendon injuries.
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Stroke following temporomandibular arthrography.
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Temporomandibular joint arthrography: a comparison between a fluoroscopic and a nonfluoroscopic technique.
A nonfluoroscopic temporomandibular joint arthrographic technique is contrasted with a more widely employed fluoroscopically guided technique. The nonfluoroscopic technique uses a posterior approach to joint injection, as contrasted with the lateral injection approach of the fluoroscopically guided technique. The advantages of the nonfluoroscopic technique are less radiation dose to the patient, less expensive and less sophisticated imaging equipment, and less potential for neurovascular trauma. The fluoroscopic technique offers greater control of the procedure, less patient and operator time, and the capability for a dynamic videofluoroscopic study. Both techniques appear to be safe and efficacious. Differences in anatomy, imaging modalities, patient radiation exposure, and potential complications are also discussed as part of this comparison.
How invasive is TMJ double-contrast arthrography in combination with cinematography? Patient discomfort versus known diagnostic gain.
There is no doubt that double-contrast TMJ fluoroscopic tomography enables a differential diagnosis and treatment in internal derangement pathosis. Its indication is, apart from the expected diagnostic gain, also determined by the degree of its invasiveness, and other alternative diagnostics being available (nuclear magnetic resonance). Data on patient discomfort and complications were gathered in 63 arthrotomographies; pain sensations and mandibular mobility, during and after the procedure in particular, were studied. We consider, along with Westesson, the procedure to be less invasive than commonly considered, once the surgeon-radiologist has gained enough experience.
Bilateral arthrography of the wrist.
In order to determine the true significance of a positive arthrogram in the investigation of wrist pain, a prospective trial was carried out in 60 patients, using the opposite asymptomatic wrist as a control. Of the 46 patients with positive findings in the symptomatic wrist, 34 (74%), had positive arthrograms in the opposite, asymptomatic, wrist. As a result of this, we conclude that a unilateral arthrogram is of little diagnostic value and we recommend the use of the opposite, asymptomatic, wrist as a control.
Arthrography of the normal and posttraumatic wrist.
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Shoulder distension arthrography in adhesive capsulitis.
Capsular retraction of the shoulder often occurs as a solitary pathological process; half of the cases are of primitive nature. In the past 10 years or more, distension of the shoulder joint has proven to be an efficient percutaneous treatment, and various techniques have been proposed. We report on our technique, which was performed on a series of 200 patients, and on the results observed in 27 patients with a precise evaluation of progressive changes in movements of the joint.
Arthrography in loosened hip prostheses. Assessment of possibilities for intra-articular therapy.
BACKGROUND: Loosening is a major complication in prosthesis surgery. Less invasive alternatives to revision surgery are required to prevent and treat prosthesis loosening. Some experimental therapies investigating alternative treatments exploit the intra-articular space as a route of administration. For efficient, local delivery of therapeutic agents a contained joint space is required. Furthermore, the volume of the joint space determines the concentration of the therapeutic ingredient in the joint. METHODS: A retrospective analysis of 221 hip arthrograms performed between 1994 and 2004 for diagnosis of prosthesis loosening was performed. All arthrograms were studied for leakage of contrast medium and the volume of injected contrast medium. RESULTS: There was a contained joint in 164 arthrograms (74%). The volume in these hips was 31+/-12.7 ml. Male patients had a larger joint volume than female patients (P=0.019). There was no difference in containment and joint volume between hips with a primary and with a revised prosthesis. CONCLUSIONS: For successful intra-articular therapy it is necessary that the injected agent remains in the jointspace. As leakage of contrast medium was shown in about a quarter of hips, this study shows that an arthrogram may be useful in the inclusion procedure for intra-articular studies to determine containment of the joint and also the volume that can be injected.
MR arthrography of the shoulder.
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Arthrography: time for reappraisal or the end of the road?
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The current role of computed tomographic arthrography of the shoulder.
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Advanced arthrography of the shoulder with CT and MR imaging.
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MR arthrography of the hip.
Hip arthroscopy can be performed on an outpatient basis and has a shorter period of rehabilitation than is necessary after an open hip arthrotomy or reconstruction. The procedure makes possible accurate diagnosis and treatment of acetabular labral tears and loose bodies. Further advancements are necessary in optical equipment; manual and motorized equipment; and simple, reliable traction devices specific for this procedure. Refinements in patient selection and the increased availability of specific outcome data will help to define the role of hip arthroscopy in orthopedic practice.