Background The arthrocentesis of the hip joint usually is performed in two ways – “blind” arthrocentesis based on anatomic landmarks and image-guided arthrocentesis with visualization of needle insertion and direction.
Objectives The aim of the study was to compare the accuracy of blind and image-guided arthrocentesis of hip joints.
Methods 96 patients with uni- or bilateral, radiologically proven hip osteoarthritis (OA) were included in the study. The total number of 187 hip joints were injected. The patients were divided into three groups according to the radiological grade of hip OA (scale of Kellgren – Lawrence) as follows: 1) 79 patients/131 hip joints - grade II; 2) 27 patients/31 hip joints - grade III; 3) 20 patients/25 hip joints - grade IV. The BMI and the presence of flexor-adductor contractures were registered. The influence of these two factors on the accuracy of the arthrocentesis was analysed. The used devices in the study were AXIOM Iconos R 200 for fluoroscopically-guided arthrocenteses and Philips HD-7 for sonografically-guided arthrocenteses. One blind arthrocentesis by lateral approach was applied for each patient (187 joints). The position of the needle was verified by injecting 1 ml contrast Ultravist with a subsequent fluoroscopic control. In case of need the needle was redirected under fluoroscopic control and the respective drug (local corticosteroid or lubricant) was injected. In 7 days, in the same patients (187 joints), it was performed the next arthrocentesis under sonographic guidance using anterior-parasagittal approach with injecting 1 ml contrast. The position of the needle was also verified and redirected if needed under fluoroscopic control with subsequent injecting of the active substance. Successful arthrocenteses were those, in which the fluoroscopic control verified a correct positioning of the needle and presence of contrast media intraarticularly. All arthrocenteses with the presence of the contrast extraarticularly, despite the visualized correct positioning of the needle, were considered as unsuccessful.
Results The successful blind arthrocenteses in OA patients with radiological grade II were 74% (97/131), while unsuccessful injections were 26% (34/131). All arthrocenteses in the group, performed with sonographic guidance were successful – 100% (131/131). In the patients with radiological grade III, successful blind arthrocentesis were performed in 61.3% (19/31) and unsuccessful applications - in 38.7% (12/31). All sonografically-guided arthrocenteses in this group were also successful - 100% (31/31). In the group patients with radiological grade IV the successful blind arthrocenteses were achieved in 40% (10/25 hip joints) and unsuccessful in 60% (15/25). In this group, successfully accomplished sonografically-guided arthrocenteses were 93% (23/25), and unsuccessful - 6% (2/25).
Conclusions The results from the study demonstrate, that there is no significant correlation between the presence of flexor-adductor contractures and the accuracy of blind arthrocentesis. Of note, a significant correlation between unsuccessful blind arthrocentesis and high BMI was found (p<0.05). Regarding the sonographically-guided arthrocentesis both presence of contractures and BMI influence significantly the accuracy of arthrocentesis (p<0.05).
Disclosure of Interest None Declared.
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