Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty

 Objective. The objective of this clinical study was to define the diagnostic value of plain radiography, digital subtraction arthrography and two-phase bone scintigraphy in patients with clinically loose or infected hip prostheses. Design. Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. Results. Digital subtraction arthrography was best (P<0.001) for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs (P=0.24) and scintigraphy (P=0.27). Digital subtraction arthrography was also the most important modality for predicting a loose femoral component (P=0.001), while the plain radiograph was of significant (P=0.04) additional value and scintigraphy was of no additional value (P=0.13) on multivariate analysis. Conclusion. Digital subtraction arthrography gives the best results in the prediction of loosening of acetabular and femoral components. Plain radiographs give additional information on loosening of the femoral component, but scintigraphy offers no additional advantage.     

Technical problems in arthrography of the painful hip arthroplasty

Arthrography following hip replacement has been reviewed. The problems encountered have been analysed with particular reference to technique and accuracy. The accepted criteria for loosening have not been consistently reliable and have led to false positive interpretation of loosening of the acetabular component. The reasons for false negative results are also considered.     

Problem prostheses: the radiologic evaluation of total joint replacement

The authors discuss and illustrate the various complications of total joint prostheses. Criteria for the evaluation of radiographs of total joint prostheses are presented.     

Digital subtraction arthrography

The technology of digital subtraction image processing was applied as a substitute for conventional arthrographic subtraction techniques in the evaluation of 29 joints in 27 patients. There were 15 total hip replacements, one total knee replacement, eight wrists, three shoulders, and two ankles. Information regarding prosthetic component loosening and ligamentous disruption of carpal bone articulations could be determined with a high degree of accuracy when compared with information gained using conventional radiographic methods. Our results indicate that this method may be a suitable substitute for other arthrographic techniques.     

Unidirectional joint communications in wrist arthrography: an evaluation of 250 cases

Although arthrographically demonstrable communications between various compartments of the wrist occur in older persons without symptoms, similar communications in younger persons may indicate clinically significant posttraumatic ligament tears and other pathologic processes. However, detection of communications varies depending on the arthrographic technique used. It has been claimed that if triple-compartment arthrography is not used in all patients, clinically significant unidirectional ligament tears may be overlooked. We determined the frequency and distribution of unidirectional intercompartmental communications, using a modification of techniques described in the literature. Separate injections of contrast material were made in sequence into the midcarpal, distal radioulnar, and radiocarpal joints of 250 consecutive patients. We found 38 unidirectional communications (17 lunotriquetral, nine scapholunate, three radial capsular, one ulnar capsular, six combined sites, and two indeterminate sites) between the midcarpal and radiocarpal joints. Nine unidirectional communications between the radiocarpal and distal radioulnar joints were found. Comparison of these results with the frequency and direction of unidirectional communications reported by others suggests that demonstration of communications depends on specific technical factors, such as which joint is injected first, the amount of contrast material used, and the delay between injections. This dependence on technical factors raises questions about the value of routine three-compartment wrist arthrography.     

Direct arthrography of the pisotriquetral joint

OBJECTIVE: The purpose of this study was to describe and evaluate a simple and safe procedure for direct arthrography of and steroid injection into the pisotriquetral joint. CONCLUSION: Direct pisotriquetral arthrography using a medial approach is an effective and easy-to-perform technique for injection of steroids.     

MR arthrography of the hip joint

MR arthrography of the hip joint is usually performed after a conventional MRI has been obtained to rule out other pathologies of the hip joint as for instance bone marrow edema or osteonecrosis of the hip. MR arthrography is mainly performed as a very special investigation, and it is executed in most cases if the clinician asks for the diagnosis of a labral lesion. In very rare cases, MR arthrography of the hip is performed to image cartilage disease or osteochondrosis dissecans or free intraarticular bodies. In this paper, the indications, the technique, and the most important pathology of the hip joint--labral lesions--will be described as well as variants of the normal acetabular labrum. After a conventional MRI of the hip joint has been performed, a MR arthrography of the hip will be obtained to search for labral pathology or cartilage disease. MR arthrography is obtained after the intraarticular injection of 10-20 ml of a 0.1 mmol solution of gadopentate-dimeglumine has been performed. The intraarticular injection can either be fluoroscopic-guided or CT-guided or directly MR-guided. After the intraarticular injection, MR arthrography will be performed by the use of paracoronal and parasagittal T1-weighted spin echo or gradient echo sequences. In cases of labral lesions (degeneration, labral tear, labral detachment) or cartilage disease MR arthrography proved to be more sensitive as conventional MRI as shown in the literature. The sensitivity of MRI to detect labral pathology was reported to be about 65%, and that of MR arthrography was reported to be about 92-95% compared to surgical results. According to the current literature, MR arthrography is the most sensitive method to delineate these kind of pathologies. Therefore, the invasive technique of MR arthrography may be justified for the correct diagnosis of these kind of pathologies after other pathologic entities have been ruled out by conventional MRI.     

Cervical facet joint arthrography

We describe a technique for cervical facet joint arthrography; a posterior approach is used. The patient is positioned prone, the neck flexed maximally, and the head turned 60-90 degrees opposite to the side of injection. The x-ray tube is angled cephalad in order to obtain a true tangent to the facet joint. The needle is inserted using fluoroscopic control in a direction parallel to the x-ray beam. Before the therapeutic infiltration, the intraarticular position of the needle is confirmed by injecting 0.3 ml of contrast medium.     

The significance of preoperative shoulder arthrography in painful arc patients

Preoperative shoulder arthrography was performed on 34 patients with painful arc syndromes. Rotator cuff rupture was diagnosed in 20 cases. Out of these the arthrography correctly showed rupture in 17 cases, while in one case rupture was not seen and two examinations were unsuccessful. Rotator cuff rupture was not found in 14 cases at operation. Of these, arthrography had been negative in eight cases and in six cases the rupture had merely been suspected. Sensitivity of shoulder arthrography in showing rotator cuff rupture was thus 85%, specificity 57% and accuracy 74%. The biceps tendon was intact in all cases with rotator cuff rupture. So-called "bicipital leakage" was seen in four cases, but its significance remains unclear.