Figure 2
Fig 3: Sequential
Injection
Injection
| The hip joints may develop arthritis (osteoarthritis, rheumatoid, gout, etc) and may be candidates for intra-articular injections when there is the presence of a positive Patricks test, FABER sign, etc. When there is a questionable diagnosis of hip pathology, the hip injection can be used as a diagnostic test with 92% sensitivity. The hip joint itself is circumscribed by a thick capsule that is contiguous with the joint space. Injection into this capsule will usually permit spreading of the contrast agent and steroid rather than injecting into the joint space proper. Figure one demonstrates the hip capsule structure whereas in figure 2, the capsule has been cut away. Placement of the needle on the proximal femoral neck, then performance of a joint arthrogram will usually define the joint space and capsule (figure 3 sequence). Typically 20mg Depomedrol plus bupivicaine may be injected for a total volume of usually less than 5ml. The abstracts below demonstrate uses and therapies of IA hip injections. Journal of Bone and Joint Surgery, Mar 1998 by Crawford, R W, We investigated 42 patients who were being considered for primary total hip arthroplasty (THA), but in whom it was uncertain whether the hip was the source of their pain. They were given an injection of local anaesthetic into the joint space. Diagnostic value of intra-articular anaesthetic in primary osteoarthritis of the hip Journal of Bone and Joint Surgery, Mar 1998 by Crawford, R W, Gie, G A, Ling, R S M, Murray, D W Of 33 patients who gained pain relief from their injection, 32 subsequently had successful THA. The remaining patient has not had surgery. The intra-articular injection of local anaesthetic is thus at least 96% sensitive. Of the nine patients who had no or only minimal pain relief from injection, one has had an unsuccessful THA, three have been successfully treated for other conditions and five have unresolved pain for which no organic basis has been established. J Rheumatol. 2004 Nov;31(11):2265-8. Intraarticular corticosteroid injection: pain relief in osteoarthritis of the hip? Kullenberg B, Runesson R, Tuvhag R, Olsson C, Resch S. Department of Orthopedics, Blekinge Hospital, Karlshamn, Sweden. bjorn.kullenberg@lthlekinge.se OBJECTIVE: Osteoarthritis (OA) is one of the most common causes of morbidity in the elderly population, and surgery is often preceded by years of pain and disability. Intraarticular corticosteroid injections in osteoarthritic joints may play a role in the therapeutic plan and can afford quick pain relief but do not alter the underlying disease. There is a paucity of well controlled studies that provide recommendations for the use of corticosteroids in OA of the hip. METHODS: A prospective analysis of 80 patients with OA of the hip and pain at rest and on bearing weight for more than 4 weeks was performed. Patients were randomized into 2 groups; group 1 (n = 40) received corticosteroid (80 mg triamcinolone acetonide) and group 2 (n = 40) local anesthetic (1% mepivacaine), injected into the hip joint under fluoroscopy. Pain, functional ability, range of motion of the joint, and analgesics consumed were registered 3 weeks postinjection. The treatment was blind for the patients and the investigators performing the followup. RESULTS: Pain for all modalities decreased after corticosteroid injection, but pain at rest decreased the most. There was significant pain reduction at the 3 (and 12) week followup. Joint range of motion increased significantly for all directions. Functional ability improved significantly after injection. We found no significant pain relief or improvement of functional ability in patients treated with local anesthetics. CONCLUSION: This study suggests that intraarticular corticosteroids might improve pain and range of motion of the affected joint in patients with hip OA. |
Algos Techniques
Intra-articular Hip Injection
Click to Enlarge
Figure 1