Ultrasound-guided hip injections: a comparative study with fluoroscopy-guided injections

The purpose was to assess ultrasound-guided injections through patient satisfaction in a comparative internally controlled study of fluoroscopic versus ultrasound technique and to quantitate the reliability of the ultrasound method. In addition, the reliability of the ultrasound method was quantitated.

This study consisted of the first 50 consecutive patients to undergo ultrasound-guided intra-articular injection of the hip (by a nurse practitioner) and who had previously undergone fluoroscopy-guided intra-articular injections by our center's fellowship-trained musculoskeletal radiologists. The patients rated the ultrasound and fluoroscopic experiences on a scale from 1 to 10 for convenience and pain; in addition, they indicated their preference between the 2 techniques. Success of the injection was documented among a total of 206 consecutive patients who underwent ultrasound-guided injections during the period of the controlled study.

For convenience, ultrasound injection had a mean rating of 9.8 whereas fluoroscopic injection had a mean rating of 3.1. For pain, ultrasound had a mean rating of 3 and fluoroscopy had a mean rating of 5.6. These differences were statistically significant (P < .01) in favor of ultrasound. For preference, 49 of 50 patients in the control study (98%) stated that they would prefer the ultrasound injection, whereas 1 was uncertain. The injection was successful in 202 of the first 206 patients (98%) to undergo ultrasound injection, whereas 4 patients required a second pass for successful injection.

In this study in-office ultrasound-guided injections of the hip were more convenient and less painful than fluoroscopy-guided hospital-based injections and were preferred by patients who have undergone both. Furthermore, the ultrasound-guided injections were performed by a recently trained physician extender in contrast to the fluoroscopic method, which was performed by experienced fellowship-trained musculoskeletal radiologists. The procedure is highly successful in the hands of a properly trained clinician.

Level II, prospective comparative study.