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. O...
Background Intraarticular (ia) corticosteroids (CS) are demonstrated to be an effective treatment in hip osteoarthritis (OA) patients refractory to conventional oral analgetic therapy. However, their efficacy in different radiological stages and in different types of bone response of the disease is not well defined. Objectives To evaluate the therapeutic effect of ia CS in patients with hip OA from different radiological grade and with different bone response. Methods 90 patients with hip OA were included in the study (15 from 4th radiological grade of Kellgren-Lawrence scale, 30 – from 3rd and 45 – from 2nd grade respectively). Additional distribution of the patients was performed according to the type of bone response as follows - atrophic, intermediate and hypertrophic type (30 patients in each group). In 15 patients a presence of synovitis was registered. 1 ia application of 40 mg methylprednisolone under fluoroscopic guidance was performed in all patients. In 90 age- and sex-matched control subjects with hip OA, who did not differ significantly from the CS-treated patient population in their radiological grade of the disease, an ia administration of local anaestetic (lidocaine) was performed also under fluoroscopic guidance. Evaluation of pain at rest and on motion (visual analogue scale, VAS 100mm), Lequesne and WOMAC index and range of motion of the injected hip joint (internal rotation) were assessed weekly in the first 3 months and monthly until the 6th month. Results A significant decrease of most of the outcome measures, e. g. VAS pain at rest and on motion, Lequesne and WOMAC index, was registered in CS-treated patients from all radiological grades 24-48 hours after the local injection (p<0.05). A significant increase in the internal rotation of the injected hip joint was also found at this period, but only in patients from 2nd and 3rd Kellgren-Lawrence grade. The duration of the therapeutic effect of ia CS continues longer for all radiological grades as compared with those of local anaesthetic (p<0.05). In addition, it lasts significantly longer in patients from 2nd radiolocal grade in comparison with more severy affected cases from 3rd and 4th grade (p<0.05). A significant difference in the assessed outcome measures after local administration of ia CS was observed between patients with and without synovitis with more pronounced effect in cases with synovial inflammation (p<0.05). Significantly better efficacy of ia CS for all of the assessed parameters was also found in patients with hypertrophic and intermediate bone response as compared with the atrophic variant of hip OA (p<0.05). Conclusions In conclusion, the therapeutic effect of ia CS is early – in the first 24-48 hours and continues significantly longer as compared with local anaesthetics. Its duration is longer in patients from 2nd radiological grade as compared with more advanced stages. The potency of the therapeutic effect depends on the type of the radiological changes as well as on the presence of synovitis. Predictors for goo...
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