Hip injection technique

Procedure: Intraarticular Hip Injection Under Fluoroscopy

Adapted from "Color Atlas of Anatomy, 4th edition"

Technique: Lateral approach with fluoroscopic guidance

Outpatient procedure

Patient position: Prone

Needle used: a 22-gauge 3.5″ quincke spinal needle is sufficient for most patients, although a 5″ may be needed for larger patients

Steps:

  • Prep and drape
  • Use the fluoroscope to find the skin over the greater trochanter
  • Make skin wheal and deeper anesthesia with local anesthetic (1% lidocaine) with 27- or 25-gauge needle at a spot 4-6cm cephalad to the greater trochanter
  • With 3.5″ 22-gauge needle, enter the skin through the skin wheal and go towards the top of the greater trochanter (#1 in the photo)
    • This will tell you you’re in the correct coronal plane
  • Redirect the needle and aim towards the femoral head/neck junction (#2 in the photo)
    • Do NOT try to inject between the femoral head and the acetabulum
  • Inject contrast to confirm intraarticular flow
    • You should be looking for the circular pattern noted in the fluoroscopic image below
  • Inject the corticosteroid or steroid/local anesthetic injectate
  • Remove needle.  Place band-aid.  Patient can go home immediately, with instructions to take it easy with that hip for 3-5 days.

Corticosteroid Hip Injection under Fluoroscopy - Courtesy Dr. Hazem Eissa - Ochsner Pain Management

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