Intra-articular hip injection using anatomic surface landmarks

Abstract

Intra-articular hip injection is a frequently used technique for diagnostic and therapeutic purposes and is gaining more importance for the early diagnosis of hip disease. It is commonly performed with imaging guidance such as ultrasonographic or fluoroscopic control. We describe our technique of injection of the hip using relative distances from anatomic surface landmarks, with the needle insertion point at the site of the proximal anterolateral portal for hip arthroscopy, with a posterior direction of 30° and targeted toward a junctional point between 2 perpendicular lines, 1 distal from the anterior superior iliac spine and the second anterior from the tip of the greater trochanter. This technique can be used without imaging guidance in the outpatient clinic. Moreover, it minimizes the need for radiographic exposure for more critical injections, such as the injection of contrast material before conducting magnetic resonance arthrogaphy of the hip.

Fig 1

Right hip in supine position with anterolateral view. The ASIS and the greater trochanter are palpated and demarcated. Line 1 is drawn from the ASIS down to the center of the patella, line 2 is drawn from the tip of the greater trochanter anteriorly perpendicular to line 1, point B is the meeting of both lines and is the target point in the coronal plane, and point A is the soft-spot entry point at the junction of the upper third and lower two-thirds of the imaginary line between the ASIS and tip of the greater trochanter.

Fig 2

Right hip with anterior-to-superior fluoroscopic view, showing the position of the needle under the C-arm. The needle is touching bone of the neck, which ensures that it has passed through the capsule of the hip joint. Although fluoroscopy is performed for research and education purposes, the purpose of this article is to show that the technique can be performed without imaging support.