Imaging-free hip arthrocentesis with a multipoint infiltration technique for hip pain: a 1-year follow-up pilot real-world study

Abstract Background: Hip arthrocentesis is essential for diagnosing and managing intra-articular pathologies, yet conventional techniques face limitations. Image-guided approaches incur radiation exposure and resource constraints, while non-guided methods exhibit high failure rates and neurovascular injury risks. To address these challenges, we developed an imaging-free hip arthrocentesis with multipoint infiltration technique (IFHAMIT), leveraging standardized anatomical landmarks and tactile feedback for intra-articular confirmation.Methods: A retrospective cohort of 107 hip pain patients underwent IFHAMIT between 2020 and 2023. Under sterile conditions, an 18–20 G needle was advanced from the anterior superior iliac spine-greater trochanter junction (lower 1/3-upper 2/3 point) at 45° until femoral neck contact. Intra-articular placement was confirmed via tactile "pop" during capsular penetration and attempted synovial fluid aspiration. Multipoint drug delivery included: intra-articular (5 ml), peri-capsular (2 ml), and optional femoral neck junctional (1 ml) injections of 1% ropivacaine; 34 non-arthroplasty patients received adjunctive platelet-rich plasma (PRP, 8 ml). Outcomes included Visual Analogue Scale (VAS) pain scores, Harris Hip Scores (HHSs), and complications over ≥12-month follow-up. Results: At mean 14.6-month follow-up, VAS scores decreased from 7.8 ± 1.3 to 2.9 ± 1.1, and HHS improved from 48.5 ± 6.2 to 85.7 ± 5.8. HHS domains showed significant gains in pain and function. No neurovascular injuries or infections occurred, and two minor self-limiting hematomas resolved spontaneously. Among 90 patients undergoing subsequent surgery, none developed iatrogenic infections. Conclusion: IFHAMIT provides sustained pain relief and functional improvement with minimal complications, suggesting its potential as a cost-effective, bedside-compatible alternative.