Intraarticular Hip Injection—Lateral Approach: Fluoroscopic Guidance

Abstract

The hip joint can be safely and effectively accessed via a lateral approach, which has its own merits and presents a path to the joint with minimal anatomic variation or radiolucent dangers. A lateral approach may be favored in patients who have a large abdominal abundance, skin infection near the groin region, an inability to tolerate supine positioning, and/or cultural reasons related to patient modesty.

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.

The hip joint can be safely and effectively accessed via a lateral approach, which has its own merits and presents a path to the joint with minimal anatomic variation or radiolucent dangers. A lateral approach may be favored in patients who have a large abdominal abundance, skin infection near the groin region, an inability to tolerate supine positioning, and/or cultural reasons related to patient modesty.

Trajectory View ( Fig. 35B.1 )

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Place the patient in the lateral recumbent position, with the target hip joint facing up (away from the table).

Fig. 35B.1

A, Fluoroscopic image of the trajectory view with bilateral femoral heads superimposed. B, Radiopaque structures, trajectory view. FH, Femoral head. C, Radiolucent structures, trajectory view. The smaller head (the target) is closer to the image intensifier. The non-targeted contralateral head is magnified because it is farther from the image intensifier (and closer to the image source).
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Obtain a lateral view of the hip joint.
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Tilt and oblique the C-arm to line up the femoral heads to obtain (or at least approximate) a “bull’s eye” view (see Fig. 35B.1 ). The smaller, target femoral head fits nicely inside the contralateral femoral head.
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  The smaller head (the target) is closer to the image intensifier. The non-targeted contralateral head is magnified (as described in Chapter 3 ) because it is farther from the image intensifier (and closer to the image source).
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The target is the femoral head–neck junction , which corresponds on the trajectory view to the center of the “upside” femoral head as seen on the lateral view.
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Be sure the needle trajectory is superior to the greater trochanter because it can block joint access.
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The needle is placed parallel to the fluoroscopic beam, further accentuating the “bull’s eye” pattern (see Fig. 35B.1A to C ).
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Advance the needle toward the target, staying near the midline between the anterior and posterior silhouettes of the femoral head, and superior to the greater trochanter.