Difference between revisions of "Ultrasound-guided hip joint injection"
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*Perform a '''preliminary sonography''', including color Doppler of the area to be punctured, to define the relationship of adjacent neurovascular structures.<ref name="YeapRobinson2017"/> | *Perform a '''preliminary sonography''', including color Doppler of the area to be punctured, to define the relationship of adjacent neurovascular structures.<ref name="YeapRobinson2017"/> | ||
*Decide which '''approach''' to use. Two common anterior approaches are typically used both with the patient lying supine: | *Decide which '''approach''' to use. Two common anterior approaches are typically used both with the patient lying supine: | ||
| − | [[File:Hip joint injection by anterior longitudinal approach.jpg|thumb|left|Anterior longitudinal approach. An arrow parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced.<ref name="YeapRobinson2017"/>]] | + | [[File:Hip joint injection by anterior longitudinal approach.jpg|thumb|left|200px|Anterior longitudinal approach. An arrow parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced.<ref name="YeapRobinson2017"/>]] |
[[File:Ultrasonography of hip joint injection by anterior longitudinal approach.jpg|thumb|Anterior longitudinal approach. The needle is introduced from an inferior and anterior approach, lateral to the femoral neurovascular bundle (arrow). A, acetabulum; H, femoral head; N, femoral neck; double arrow – anterior joint recess.<ref name="YeapRobinson2017"/>]] | [[File:Ultrasonography of hip joint injection by anterior longitudinal approach.jpg|thumb|Anterior longitudinal approach. The needle is introduced from an inferior and anterior approach, lateral to the femoral neurovascular bundle (arrow). A, acetabulum; H, femoral head; N, femoral neck; double arrow – anterior joint recess.<ref name="YeapRobinson2017"/>]] | ||
:*The '''anterior longitudinal''' approach: the probe is aligned along the long axis of the femoral neck. The needle is introduced from an anteroinferior approach and is passed into the anterior joint recess at the femoral head-neck junction. | :*The '''anterior longitudinal''' approach: the probe is aligned along the long axis of the femoral neck. The needle is introduced from an anteroinferior approach and is passed into the anterior joint recess at the femoral head-neck junction. | ||
Revision as of 20:38, 21 March 2019
File:Hip prosthesis components.jpg
Main components of a hip prosthesis[1]
Author:
Mikael Häggström [notes 1]
Contents
Planning
Choice of modality
Ultrasonography is generally superior for injections in the hip joint, because of portability, lack of ionizing radiation and real-time visualisation of soft tissues and neurovascular structures.[2]
Bleeding
The risk of clinically significant bleeding is minimal, so coagulation tests are not needed before the procedure. It can for example be performed during chronic warfarin therapy with therapeutic coagulation levels.[3]
Transducer choice
Preferably use a high-frequency (> 10 MHz) linear array transducer.[2] A lower-frequency curvilinear probes may occasionally be required in larger patients.[2]
Injectate
The total volume injected is usually 6–7ml.[2]
For pain relief in osteoarthritis, for example:
- Local anesthetic
- 300mg lidocaine (such as 3 ml of 10%)
- 30mg mepivacaine (such as 3 ml of 1% Carbocaine)
- 25mg bupivacaine (such as 5ml of Marcaine 0.5%)[4]
- Cortisone, for example:
- 40mg triamcinolone (such as 1ml of 40 mg/ml)[4]
Procedure
- Perform a preliminary sonography, including color Doppler of the area to be punctured, to define the relationship of adjacent neurovascular structures.[2]
- Decide which approach to use. Two common anterior approaches are typically used both with the patient lying supine:
File:Hip joint injection by anterior longitudinal approach.jpg
Anterior longitudinal approach. An arrow parallel to the long axis of the transducer is drawn on the skin adjacent to the end of transducer where the needle will be introduced.[2]
File:Ultrasonography of hip joint injection by anterior longitudinal approach.jpg
Anterior longitudinal approach. The needle is introduced from an inferior and anterior approach, lateral to the femoral neurovascular bundle (arrow). A, acetabulum; H, femoral head; N, femoral neck; double arrow – anterior joint recess.[2]
- The anterior longitudinal approach: the probe is aligned along the long axis of the femoral neck. The needle is introduced from an anteroinferior approach and is passed into the anterior joint recess at the femoral head-neck junction.
- The anterolateral approach, with the ultrasound probe oriented axially and the femoral head and acetabular rim in view. This often shortens the distance from needle skin entry to joint compared to the longitudinal approach making it a useful approach in larger patients. The introduced needle remains lateral to the femoral neurovascular bundle, and the needle is advanced until its tip rests on the femoral head.
File:Ultrasonography of hip joint injection by anterolateral approach.jpg
Anterolateral approach, here shown as a transverse image. The needle will rest on the femoral head (arrow). A, acetabulum; H, femoral head; N, femoral neck; LAT, lateral; MED, medial.[2]
- Draw a line parallel to the long axis of the transducer, on the skin adjacent to the end of the transducer is where the needle will be introduced.
- Perform sterile preparation of the entire injection field, including adjacent skin where the gel and probe are applied. Areas of superficial infection such as cellulitis or abscess should be avoided to prevent deeper spread.[2]
- Using the previous mark, insert the needle, directed toward the intended target. It can be done by a freehand technique,[2] but a needle guide may be used. Needles with a Birmingham Gauge of 22–24 are sufficed for most injections.[2]
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ Andrew Still (2002-11-02). Total Hip Replacement. University of Southern California. Retrieved on 2017-01-05.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Initially largely copied from: Yeap, Phey Ming; Robinson, Philip (2017). "Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin
". Journal of the Belgian Society of Radiology 101 (S2). doi:. ISSN 2514-8281.
Creative Commons Attribution 4.0 International License (CC-BY 4.0) - ↑ Ahmed, Imdad; Gertner, Elie (2012). "Safety of Arthrocentesis and Joint Injection in Patients Receiving Anticoagulation at Therapeutic Levels ". The American Journal of Medicine 125 (3): 265–269. doi:. ISSN 00029343.
- ↑ 4.0 4.1 Anderson, Erik; Herring, Andrew; Bailey, Caitlin; Mantuani, Daniel; Nagdev, Arun (2013). "Ultrasound-guided Intraarticular Hip Injection for Osteoarthritis Pain in the Emergency Department ". Western Journal of Emergency Medicine 14 (5): 505–508. doi:. ISSN 1936900X.
