Ultrasound-Guided Intra-articular Hip Injection Technique

MATERIALS A 25-gauge 1.5-inch needle attached to a syringe for local anesthesia A 22-gauge 3.5-inch needle for injectate A syringe filled with local anesthetic, steroid, and/or other injectate <10-MHz curvilinear transducer A sterile ultrasound probe cover with sterile ultrasound gel Chlorhexidine or another skin antiseptic 4 × 4 gauze Band-Aid Sterile gloves PATIENT POSITIONING The patient is placed supine with the leg extended and the hip in a neutral position. The provider should be seated on the same side as the affected hip, and the ultrasound screen should be on the side of the unaffected hip in direct view between the provider, the projected needle trajectory, and the transducer. PROBE POSITIONING The transducer should be placed in an anatomic transverse oblique plane in long axis over the expected trajectory of the femoral neck. This will optimize visualization of the femoral head-neck junction and hip joint capsule. NEEDLE TECHNIQUE With the syringe and needle to be used for local anesthesia, a skin wheal should be created. Then the needle is advanced using an in-plane, inferolateral-to-superomedial approach toward the joint recess at the femoral head-neck junction while anesthetizing skin and subcutaneous tissue with local anesthetic. The needle for local anesthesia is then withdrawn. Following the same tract that was just anesthetized, the spinal needle is then advanced in the same trajectory and should pass through the iliofemoral ligament, which can be felt as a change in resistance. Once the final spinal needle position is achieved in the anterior joint recess, the stylet is removed from the spinal needle, and the syringe with injectate is connected and injected with excellent arthrogram effect (Video). PEARLS AND PITFALLS Care should be taken to scan preprocedurally to identify and avoid the femoral neurovascular bundle, located medially. Before injection when the transducer is in the anatomic transverse oblique plane in long axis over the femoral neck, attention should also be placed on the ascending branch of the lateral femoral circumflex artery, which should be avoided when planning trajectory of the needle. Video Legends Ultrasound-Guided Injection Series: Intra-articular Hip, https://links.lww.com/PHM/C611