An inexpensive and accurate method for hip injections without the use of imaging

Intraarticular injections of the hip have traditionally required sonographic or fluoroscopic guidance assistance. Previous studies report high failure rates with injections based solely on anatomic landmarks.

To examine the accuracy of a lateral injection technique in osteoarthritic patients without using image assistance.

This study was conducted in the operating room in 40 consecutive patients about to undergo total hip arthroplasty. Before sedation, each patient was positioned in a lateral decubitus position. Under sterile conditions, methylene blue dye was injected through an 18G spinal needle that was inserted 1 cm proximal to the midline of the greater trochanter, and directed toward the superolateral aspect of the femoral neck, according to preoperative hip x-rays. Accuracy was assessed intraoperatively by examining the joint and surrounding tissues for the presence of dye.

Injections were successful in 6 of the first 10 (60%) patients and in 25 of the remaining 30 (83.3%) patients. Overall, injections were successful in 31 of 40 (77.5%) patients with disseminated dye solely in the intracapsular space. In all 9 unsuccessful injections, the dye was located distal to the joint, along with the more lateral aspect of the femoral neck.

Accuracy of injections, to the hip joint, based on anatomic landmarks and preoperative x-rays is similar to those documented for knee injections in the literature. When unsuccessful, the injected material was not found close to neurovascular structures. This technique has an acceptable learning curve and can be used safely in a standard office setting.