Presentation
Hip pain worse with activity. Prior radiographs show joint space loss. For image guided anesthetic arthrogram.
Patient Data
Injection of contrast
Advanced bone on bone arthritis in the weight-bearing aspect of the hip with an acetabular geode.
A 22G 90mm Quincke needle targets the superolateral aspect of the femoral neck. Administration of iodinated contrast under fluoroscopy shows most of the injected contrast extends around the head neck portion of the joint. A tiny amount extends from the needle in a linear fashion in a vertical orientation indicating the needle is partly in the soft tissues.
Post injectate
Iodinated contrast and the anesthetic arthrogram solution distends the joint, which outlines the irregular contour of the joint which most likely represent synovitis/ synovial hypertrophy.
Case Discussion
The steps of fluoroscopic-guided anesthetic arthrograms include positioning the patient, optimizing imaged area, cleaning the skin, introducing a needle into the joint, confirming an intra-articular position by injecting iodinated contrast and subsequently giving the anesthetic arthrogram injectate.
It is important to review previous imaging and compare current imaging findings. In this case, advanced osteoarthritis in the weight-bearing aspect of the hip are evident.
The hip joint should be smooth in contour and this should be appreciated when injecting the iodinated contrast. In this case the joint is irregular with globular components which is most commonly seen in those with synovitis/ synovial hypertrophy. In younger patients and with a different pattern of arthropathy, an inflammatory and /or infective causes should be considered.
The anesthetic arthrogram injectate, in this case, did not contain iodinated contrast and contained 40mg triamcinolone (40mg/1mL) and 3mL 0.5% ropivacaine.