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Gadolinium injected concurrently with anesthetic can result in false-negative diagnostic intra-articular hip injections

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this paper was to evaluate the response to intra-articular hip injections with and without concurrent gadolinium administration. Our secondary outcome was to compare post-operative outcomes between patients with an initial false-negative gadolinium-containing injection and a matched control group.

Methods

Patients receiving a series of two hip diagnostic intra-articular injections (DIAI), the first with gadolinium for concurrent MRA and the second without gadolinium, were retrospectively identified. Pain response to DIAI, injectate volume, local anesthetic volume, inclusion of corticosteroids, and method of injection were compared between injections. False-negative injection was defined as < 50% pain relief with concurrent gadolinium, but ≥ 50% pain relief with subsequent anesthetic injection without gadolinium. False-negative injections in patients that ultimately underwent primary hip arthroscopy were identified from this cohort and matched in a 3:1 ratio to a control cohort to compare short-term post-operative single assessment numerical evaluation (SANE) outcomes.

Results

Forty-three patients underwent a series of anesthetic injections with and without gadolinium and met inclusion and exclusion criteria. Pain response was significantly different in injections performed with and without gadolinium (18% vs. 81%; p < 0.001). There were significant differences in total injectate volume, local anesthetic volume, corticosteroid use, and method of injection between injections, but these variables were not correlated with pain response. Fifteen patients with false-negative responses to injection underwent primary hip arthroscopy and were matched in a 3:1 ratio to a control cohort. There was no difference in short-term post-operative SANE scores between the gadolinium-sensitive and control groups (81.6 vs. 80.0, n.s.).

Conclusion

Concurrent administration of intra-articular gadolinium with DIAI may result in a false-negative response to anesthetic. Additionally, in patients with initial false-negative DIAI with gadolinium, short-term post-operative outcomes after hip arthroscopy are similar to a matched cohort.

Level of Evidence

Level III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas St 708 CSB, Charleston, SC, 29425, USA

    W. Michael Pullen

  2. Reno Orthopaedic Clinic, Reno, NV, USA

    Daniel M. Curtis

  3. Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA

    Christopher Jamero, Nicole Segovia & Marc R. Safran

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  1. W. Michael Pullen
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  2. Daniel M. Curtis
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  3. Christopher Jamero
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  4. Nicole Segovia
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  5. Marc R. Safran
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Corresponding author

Correspondence to W. Michael Pullen.

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Conflict of interest

WMP, CJ, and NS have no disclosures to report. DMC reports the following disclosure: Arthroscopy Journal, Editorial Board. MRS reports the following disclosures: American Journal of Sports Medicine: Editorial or Governing Board, Biomimedica: stock or stock options and unpaid consultant; DJ Orthopedics: IP royalties; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or Committee Member; JISAKOS: Editorial or Governing Board; Journal of Hip Preservation Surgery: Editorial or Governing Board; Medacta: paid consultant and paid presenter or speaker; Saunders/Mosby-Elsevier: publishing royalties, financial or material support; Smith & Nephew: IP royalties; paid presenter or speaker and research support; Stryker: IP royalties; Subchondral Solutions: stock or stock options and unpaid consultant; Wolters Kluwer Health—Lippincott Williams & Wilkins: publishing royalties, financial or material support.

Ethical approval

IRB Information: Protocol #49494 was approved by the Stanford University Institutional Review Board on 8/16/20.

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Pullen, W.M., Curtis, D.M., Jamero, C. et al. Gadolinium injected concurrently with anesthetic can result in false-negative diagnostic intra-articular hip injections. Knee Surg Sports Traumatol Arthrosc 31, 2746–2753 (2023). https://doi.org/10.1007/s00167-023-07392-1

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  • DOI: https://doi.org/10.1007/s00167-023-07392-1

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