Carbon dioxide gas arthrography for the evaluation of pediatric hip conditions: what is the risk and reliability?

Background: Various pediatric conditions often necessitate a morphologic examination of the hip joint in infancy or childhood, and multiple imaging options have been employed to achieve this goal. Arthrography is one such modality. Different types of contrast media have been utilized and include pharmacologic contrast agents, air, and carbon dioxide. There are scattered reports of complications related to the typical various media used during arthrography. Some of the most concerning are related to gas emboli following the use of air or carbon dioxide. This study assesses the potential complications of carbon dioxide hip arthrography in a series of children over a 12-year period. Methods: A retrospective review of the medical records of children between the ages of 0 and 3 years who underwent hip arthrography using carbon dioxide gas as the contrast medium was conducted. Outcome measures analyzed included volume of CO2 injected, vital signs, and perioperative and postoperative end-tidal CO2. Results: Our study population was comprised of 118 hips in 90 children. We found no correlation between the volume of CO2 injected and the patient’s vital signs or end-tidal CO2 at any point during the perioperative or postoperative period. None of the children exhibited any evidence for cardiopulmonary compromise or clinical signs of embolism. Discussion: To our knowledge, there have been no large studies reporting on carbon dioxide arthrography and its potential complications. There were no gas embolisms and/or cardiopulmonary complications in our patients in the perioperative, postoperative, or 1-year follow-up period. Utilizing carbon dioxide gas as the contrast media for hip arthrography in children is safe and can help aid in the treatment of pediatric hip conditions. Level of Evidence: Therapeutic Level IV.