Ultrasound-guided hydrodilatation for adhesive capsulitis of the hip is a safe and effective treatment

Abstract

Purpose: Adhesive capsulitis of the hip (ACH) is likely that this condition had been previously encountered, but easily unrecognised. We investigated the clinical features of patients with ACH, the efficacy of ultrasound-guided intra-articular hydrodilatation, and the patients' prognosis.

Methods: We enrolled 84 patients (93 hips) who visited the outpatient clinic from August 2018 to November 2019. ACH was diagnosed by restricted range of motion and sharp pain when turning with the affected leg fixed on the ground. We evaluated patient demographics and associated intra-articular pathologies found on magnetic resonance angiography (MRA) images. Injections were performed twice at two week intervals with a mixture of 0.5% lidocaine (25 mL) and triamcinolone (40 mg; 1 mL) with capsular distension under ultrasound guidance. Patients were assessed before and after treatment using a visual analogue scale (VAS), hip disability and osteoarthritis outcome score (HOOS), hip range of motion (ROM), and distance from floor to knee (DFK) when sitting in the cross-legged position.

Results: On MRA, 18 patients had abnormal findings (eight labral tears, seven abductor tendinosis, three primary arthrosis). The mean VAS decreased from 7.1 ± 1.1 to 0.8 ± 0.9 after the last injection, and the HOOS improved in all subsets. The mean DFK decreased from 17.9 ± 4.8 to 9.7 ± 2.8 cm, and passive ROM showed improvement, especially in flexion and rotation. In seven patients, symptom recurrence was reported a mean of 4.1 months after the latest injection, but no independent risk factor for recurrence was identified.

Conclusion: Based on these current observations, patients with ACH may receive relief from hip joint pain and experience improved function with a timely diagnosis and effective treatment.

Keywords: Adhesive capsulitis; Capsule; Hip; Hydrodilatation; Ultrasound.

Fig. 1

Images of the sagittal-oblique plane parallel to the femoral neck in a 47-year-old male patient in the supine position. Note the path of the needle to reach the joint cavity (white arrowheads). (A) Ultrasound-guided intra-articular injection was performed by placing the curvilinear transducer firmly over the area of the femoral head-neck junction in the long axis and slightly oblique view (anterolateral approach). (B) The anterior recess (*) of the hip joint over the femoral neck (normally about 4 to 6 mm thick) is targeted. (C) The needle is visualised as a hyperechoic line (arrow) and is targeted to the anterior synovial recess located at the neck of the femur. Two millilitres of fluid was injected to confirm the location of the needle tip. (D) After ultrasound-guided injection, maximum tolerable distension was achieved without rupturing the capsule (double arrow). FH, femoral head; AR, anterior recess of hip joint