HIP ARTHROGRAPHY, ASPIRATION, BLOCK, AND BURSOGRAPHY - 09/09/11
Resumen |
The value of contrast arthrography of the hip joint is well-documented in this century. Evaluation of the unossified structures of the hip in developmental dysplasia of the hip (DDH), Legg-Calvé-Perthes (LCP) disease, and complex congenital malformations, such as proximal femoral focal deficiency was a major stimulus to the development of this imaging modality. In these conditions, arthrography demonstrates the femoroacetabular relationships in various positions. This information is not currently provided by static MR imaging, where the hips are studied in a neutral position, nor with CT or sonography.21, 26, 27, 28, 41, 46
In 1939 Severin,46 working at the Orthopaedic Clinic in Stockholm, was one of the first to report in the English-language literature on the usefulness of contrast arthrography in children's hips. He was influenced by earlier investigators who, during the previous decade, reported this new technique in the French- and German-language literature. Fluoroscopic monitoring of pediatric hip arthrography, as it became available, was advocated by Ozonoff40 in 1973. Notwithstanding the successful application of contrast arthrography in children, it was not until 1974 that Razzano et al43 presented a method for adult hip arthrography.
Unexplained hip pain in adults, accompanied by normal radiographs, stimulated further expansion of arthrographic techniques, such as aspiration arthrography and anesthetic arthrography (hip block). Additional imaging, such as CT arthrography, MR imaging arthrography, and radionuclide scintigraphy, soon followed. By the 1970s, adult hip arthrography included preliminary aspiration of the hip joint. Razzano et al43 reported a series of 66 patients with diagnoses such as infection, rheumatoid arthritis, osteoarthritis, neuropathy, dysplasia, avascular necrosis, and implant loosening.36
In 1974, subtraction arthrography, adapted from neurovascular radiology, was implemented for diagnosis of loose cemented joint replacements, allowing improved visualization of opaque contrast in barium-impregnated cement–bone interfaces and in metal–bone interfaces.45 The efficacy of arthrography in diagnosing synovial chondromatosis, adhesive capsulitis, and transient osteopenia was introduced in 1977. The need to exclude infection by performing aspiration prior to arthrography in adhesive capsulitis and transient osteopenia was emphasized.36 Aspiration prior to total hip revision was studied in a large series by O'Neill and Harris39 and Barrack and Harris.5
The years from 1991 to 1994 saw the concept of the diagnostic usefulness of intra-articular bupivacaine (hip block) in distinguishing radicular pain (either from the spine to the hip or from the hip or spine to the knee) from pain arising within the hip joint or from the joint capsule.8, 30 Arthrography for labral pathology, in children as well as adults, is currently evaluated by CT or MR imaging. This article reviews hip arthrography, hip aspiration, hip block, and iliopsoas bursography. MR imaging and CT arthrography are not discussed.
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| Address reprint requests to Piran Aliabadi, MD, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 |
Vol 36 - N° 4
P. 673-690 - juillet 1998 Regresar al número
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- WRIST ARTHROGRAPHY TODAY
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