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Ultrasound-Guided Hip Pericapsular, Rectus Femoris Peritendinous, and Iliopsoas Bursa Injections Improve
Meghan E Sahr1, Hanley Ong2,3, Karthik Krishnan2,3
1Department of Radiology and Imaging Hospital for Special Surgery New York New York U.S.A.
Purpose:
To determine the short- and medium-term efficacy of ultrasound-guided hip pericapsular, rectus femoris peritendinous, and iliopsoas bursa injections with anesthetic and corticosteroid to treat post-arthroscopy hip pain, and if any operative variables correlated with response likelihood.
Methods:
Retrospective search for ultrasound-guided injections performed from January 2015 to March 2024 was conducted. Inclusion criteria were history of hip arthroscopy to treat femoroacetabular impingement syndrome, persistent bothersome symptoms after conservative management including physical therapy, exclusion of intra-articular pain sources; and treatment with simultaneous ultrasound-guided injection of the hip capsule, rectus femoris tendon, and iliopsoas bursa. Responses immediately after the injection and at the next follow-up visit were recorded. Likelihood of positive injection response was correlated with operative variables.
Results:
Fifty-two injections in the same number of hips (28 men, 31 right hips) were performed a median of 308 days, range [121-1300] following hip arthroscopy to treat femoroacetabular impingement syndrome. Immediately after the injection, 42 patients experienced improvement in symptoms, 2 had no improvement and 8 were unable to assess the immediate effect. The pre-injection average visual analog score of 3.5 [SD ± 2.4] decreased to 0.4 [SD ± 1] immediately after the injections. At the next clinical follow-up visit, 36 (69%) reported at least some improvement (5 (9%) mild, 13 (25%) moderate, and 18 (35%) marked). 14 (27%) patients reported no benefit and 2 (4%) were lost to follow-up. At last clinical follow-up, 29 cases had no or manageable symptoms, 7 underwent another surgery, 6 were discharged to pain management, and 10 had no further follow-up data. There was no correlation between surgical variables and the degree of improvement at follow-up (P = .266-1).
Conclusions:
Patients with post-arthroscopy hip pain with adequately treated intra-articular factors may benefit from ultrasound-guided injections targeting the joint capsule, rectus femoris origin, and iliopsoas bursa.
Level Of Evidence:
Level IV, therapeutic retrospective case series.