What are the indications for an athrography?
joint pain evaluation including labral tears, ligament injuries, cartilage defects
assessment of joint instability like dislocations, capsular injuries
suspected synovial disease or injection like septic arthritis and inflammatory arthritis
pre-MRI contrast-enhancing imaging
post-surgical assessment like labral or meniscal repair and joint replacement complications
What are absolute contraindications of an athrogram?
active joint infection or septic arthritis
severe allergy to iodinated or gadolinium-based contrast media
uncontrolled bleeding disorders or coagulopathy
What are relative contraindications of an arthrogram?
significant joint effusion (can consider a joint aspiration first)
advanced osteoarthritis with severe joint space narrowing
What imaging and sterile equipment is needed?
fluoroscopy or ultrasound machine
sterile gloves, gown, mask and drapes
chlorohexidine or povidone-iondine skin prep
sterile gauze and transparent dressings
What needles and syringes are needed?
22-25G spinal or hypodermic needle for local anesthesia
18-22G spinal needle for joint access
10 mL and 50 mL syringes for contrast and anesthetic administration
What contrast agents are needed?
for fluoroscopic arthrography: water soluble iodinated contrast like Iohexol and Iodixanol
for MRI arthrography: gadolinium-based contrast (diluted in saline or iodinated contrast)
What additional supplies are needed?
lidocaine 1% for local anesthesia
joint aspiration kit (if fluid analysis is required)
compression bandage for post-procedure dressing
Why would ultrasound be used for a pre-procedural imaging eval?
it can be used to guide needle placement in deeper joints like the hip or in obese patients
How would fluoroscopy be used which is the primary modality for arthrography
it is used to confirm intra-articular contrast injection
it provides real-time needle visualization
How would the patient be positioned for a hip athrogram?
supine with leg slightly abducted
How would the patient be positioned for a shoulder arthrogram?
supine or seated, arm in neutral position
How would the patient be positioned for a knee arthrogram?
supine with knee slightly flexed
How much contrast should be injected?
2-10mL depending on the joint size
What modification would you make if the patient had deep joints?
use a longer spinal needle or ultrasound guidance
What would you do if there was significant joint effusion?
consider joint aspiration before contrast injection
what modification would you make if there was a intra-articular pathology?
Adjust contrast volume based on joint capacity
How would you avoid a joint infection (septic arthritis)?
use sterile technique
How would you avoid contrast leakage or extravasation?
avoid excessive injection force
how would you avoid an allergic reaction to the contrast agent?
ensure proper screening of the patient
What is the next step after cleaning, draping, and lidocaine?
insertion of an 18-22G needle under fluoroscopy
How will you know when you’re in the joint?
you will notice a decreased in resistance
After injection contrast what will you do?
Observe the real time contrast distribution within the joint
What is considered diagnostic success?
contrast was successfully distributed in the joint space
no extravasation or leakage
MRI or CT arthrogram was completed without complication
What is considered a therapeutic success?
symptom relief post-injection
improved joint function or pain reduction
