Intraarticular Hip Injection—Anterior Approach: Fluoroscopic Guidance

Abstract

Intraarticular hip injection can be used for both diagnosing and treating pain emanating from the femoro-acetabular joint. It can also be used to deliver contrast prior to a magnetic resonance (MR) arthrogram.

Keywords

femoro-acetabular joint, greater trochanter, Hip, Hip Injection, labrum fluoroscopy, osteoarthritis, trochanteric bursitis

Note: Please see pages ii , iii for a list of anatomic terms/abbreviations used throughout this book.

Intraarticular hip injection can be used for both diagnosing and treating pain emanating from the femoro-acetabular joint. It can also be used to deliver contrast prior to a magnetic resonance (MR) arthrogram.

In this chapter, we describe an anterior approach with the patient in a supine position. This can be beneficial when performing bilateral hip injections and is sometimes the preferred position of comfort for the patient. Primary safety considerations include avoiding the femoral nerve, artery, and vein, which lie anterior to the medial aspect of the femoro-acetabular joint. Additionally, branches of the lateral circumflex femoral artery course along the anterior intertrochanteric line and femoral neck, some of which anastomose with the medial circumflex femoral artery, therefore, contributing blood supply to the femoral neck and head. Theoretically, occlusion of these vessels could cause avascular necrosis.

Trajectory View ( Fig. 35A.1 )

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Place the patient in the supine position.

Fig. 35A.1

A, Fluoroscopic image of the trajectory view. B, Radiopaque structures, trajectory view. FH, Femoral head; FN, femoral neck. C, Radiolucent structures, trajectory view.
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Position the C-arm over the target hip joint.
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Tilt the C-arm caudally and oblique medially or laterally to obtain the trajectory view so that the needle entry is inferior to the inguinal crease, with the needle entering the proximal thigh and not the abdomen (see Fig. 35A.1 ).
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The target is approximately at the midline of the anterior femoral head–neck junction.
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The needle is placed parallel to the fluoroscopic beam.