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Ultrasound is being used more as a diagnostic tool in orthopaedic surgery
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Ultrasound has developed significantly in several medical specialties during last decade, including within orthopaedics and traumatology. With newer ultrasound probes or transducers and the improved quality of the dynamic pictures obtained, even an older orthopaedic surgeon like me can now see what the radiologist means when he or she prints or freezes a screen that displays an ultrasound image to provide instruction on his or her observations.
Today, ultrasound is used substantially in several areas within orthopaedics and traumatology. It has moved away from being a tool solely used by the radiologist into one that is effectively used in the hands of orthopaedic and traumatology surgeons. One of the most remarkable applications of ultrasound diagnostics, for me, is still its use to screen or diagnose dysplastic/loose or dislocated hips in a newborn child. Through use of ultrasound diagnostics, it has been shown that fewer diseased hips are overlooked in the newborn population and early treatment can be initiated to prevent the suffering associated with the detection of displaced or dislocated hips that occurs later in childhood.
Diagnose sports-related lesions
Also, our colleagues who treat sports injuries report having major success using ultrasound for diagnosing meniscal lesions, tendon lesions or ruptures, inflammatory lesions around muscles and joints and when they use the ultrasound equipment themselves in their outpatient clinics. This results in a diagnosis that is immediate and does not require a referral to the radiologist for assistance and input.
Shoulder surgeons report similar success with use of this technology. It is already standard to use ultrasound in the diagnostics of lesions around or within the shoulder joint. At our clinic, shoulder surgeons have taken this a step further and are educating specialized nurses, so they can perform ultrasound procedures.
In the lower limb joint replacement unit, we still ask the radiologist to perform the ultrasound examination. We could do it ourselves, but this approach makes sense because our high-volume hip and knee replacement center has a unique collaboration with our department of radiology.
Complicated total joint replacements
In complicated cases that mainly involve hips and knee that, after joint replacement and at first clinical examination still have unexplained pain or disability, we can refer patients directly to the radiologist. The radiologist then decides which diagnostic tool to use (MRI, CT or ultrasound). Often the next step is taken, which is to puncture the joint under ultrasound guidance to obtain fluid for culturing. This makes any further examination needed in such cases quick and efficient.
The development of new opportunities to use ultrasound for musculoskeletal diagnostics will occur in next decade, at which time these will yield more specific results. As a joint replacement surgeon, I look forward to the day when we can use ultrasound to determine if an implant is loose or well-fixed and to the time when ultrasound can be used more widely as a high-quality, dedicated imaging technique. Going forward, ultrasound will prove to be a dynamic diagnostic tool that will further improve the orthopaedic surgeon’s ability to examine patients, make a sure diagnosis, initiate treatment earlier and minimize suffering and disability.
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- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Rd., Thorofare, NJ 08086, USA; email: orthopedics@healio.com.
Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.