Intra-articular Hip Injection Using Anatomical and Radiological Landmarks Without the Use of Ultrasound or Radiological Guidance

Abstract

INTRODUCTION: Intra-articular hip injections are routinely performed under sonographic or fluoroscopic guidance in order to improve accuracy. The purpose of this study was to evaluate the safety and accuracy of a hip injection technique that does not require the use of fluoroscopic or ultrasound guidance and can be performed in the clinic. A combination of radiographic and anatomic landmarks was used in order to perform the hip injection, based on the use of simple hip radiographs. METHODS: In this prospective study 35 patients with hip osteoarthritis or femoroacetabular impingement were included. All patients underwent intra-articular hip joint injection using the technique we describe. The injection location was determined based on measurements performed on hip radiographs using as reference points fixed anatomical landmarks, i.e., the anterior superior iliac spine (ASIS), the cephalic, and caudal femoral head-neck junctions. The vertical distance between the ASIS and the greater trochanter and the horizontal distance between the two head-neck junctions, and the vertical line were also measured. The accuracy of the injection was assessed using ultrasound examination before and after the injection in order to verify intra-articular fluid injection. RESULTS: Intra-articular hip joint injections using the described non-guided technique were successful in 33 of 35 (94.3%) patients without any complications. CONCLUSION:  Hip injections can be performed with high accuracy without the need for radiological or ultrasound guidance using the described technique. The combination of radiological and anatomical landmarks to perform intra-articular hip injections is safe, cost-effective, and accurate.