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Limited Effectiveness of Sonography in Revealing Hip Joint Effusion: Preliminary Results in 21 Adult Patients with Native and Postoperative Hips

Patrick N. Weybright1, Jon A. Jacobson1, Kristyn H. Murry1,2, John Lin1,3, David P. Fessell1,4, David A. Jamadar1, Mohammed Kabeto5 and Curtis W. Hayes1

1 Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0326.
2 Present address: Department of Radiology, St. Joseph Mercy Health System, 5301 Huron River Dr., Ann Arbor, MI 48197.
3 Present address: Valley Radiologists, Ltd., 5322 W. Northern Ave., Glendale, AZ 85301.
4 Present address: Akron Radiology Inc., 525 E. Market St., Akron, OH 44304.
5 Center for Health Outcomes, Innovation, and Cost Effectiveness Studies, 3A-14, 300 N. Ingalls Bldg., Ann Arbor, MI 48109.



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Fig. 1. 78-year-old woman with native hip and infected joint effusion. Anterior sonogram obtained longitudinal to femoral neck shows 5 mm of anterior recess distention. Three milliliters of anechoic fluid (arrow) was aspirated with sonographic guidance and found to be infected. Note normal anterior and posterior layers of anterior joint capsule (arrowheads). H = femoral head, N = femoral neck.

 


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Fig. 2. 26-year-old woman with native hip and no joint effusion. Anterior sonogram obtained longitudinal to femoral neck shows 6 mm of hypoechogenicity (arrows). No fluid was present at fluoroscopic aspiration. H = femoral head, N = femoral neck.

 


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Fig. 3. 20-year-old woman with native hip and no effusion and probable synovitis. Anterior sonogram obtained longitudinal to femoral neck shows 25 mm of hypoechoic anterior recess distention (arrows). Internal arterial flow was identified with Doppler waveform (not shown). No fluid was present at fluoroscopic aspiration. H = femoral head, N = femoral neck.

 


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Fig. 4. 36-year-old woman with hip arthroplasty and no joint effusion. Anterior sonogram obtained longitudinally to femoral neck prosthesis shows 7 mm of hypoechogenicity (straight arrows) over neck (N) of prosthesis and 6 mm of hypoechoic distention of pseudocapsule (curved arrow) over native femur (F). No fluid was present at fluoroscopic aspiration. Note reverberation artifact from metal prosthesis (arrowheads). H = head of prosthesis, A = acetabulum.

 


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Fig. 5. 66-year-old woman with hip arthroplasty and joint effusion. Anterior sonogram obtained longitudinally to femoral neck prosthesis shows 7 mm of hypoechogenicity (straight arrows) over neck (N) of prosthesis and 3 mm of hypoechoic distention of pseudocapsule (curved arrow) over native femur (F). Joint fluid was present at fluoroscopic aspiration. Note reverberation artifact from metal prosthesis (arrowheads). H = head of prosthesis, A = acetabulum.

 


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Fig. 6A. 36-year-old man with hip arthroplasty and extraarticular extension of joint effusion. Anterior sonogram obtained longitudinally to femoral neck prosthesis shows 25 mm of hypoechogenicity (straight arrows) over neck (N) of prosthesis and 10 mm of hypoechoic distention of pseudocapsule (curved arrow) over native femur (F). Joint fluid was present at sonographic aspiration. Note reverberation artifact from metal prosthesis (arrowheads).

 


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Fig. 6B. 36-year-old man with hip arthroplasty and extraarticular extension of joint effusion. Anterior sonogram longitudinal to femoral neck prosthesis shows extraarticular extension of joint effusion (curved arrow). Note reverberation artifact from metal prosthesis (arrowheads). Straight arrows indicate hypoechogenicity over femoral neck (N).

 

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