Hip joint intraarticular injection is used to treat inflammation of the hip secondary to rheumatoid arthritis or osteoarthritis.
After informed consent is obtained, the patient is placed in the supine position with the leg straight and externally rotated. A point is marked at 2 cm below the anterosuperior spine of the ilium and 3 cm laterally to the palpated femoral pulse at the level of the superior edge of the greater trochanter. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 3.5-in. (9-cm), 21-gauge needle is inserted at the mark in the posterior medial direction at an angle 60 degrees to the skin. The needle is advanced through the tough capsular ligaments to the bone and slightly withdrawn. Under fluoroscopy, contrast medium is injected to confirm appropriate needle placement. Aspiration is attempted until the needle has entered the synovial space. If there is an effusion of the joint, the aspiration is completed. After negative aspiration or if the aspirated fluid is noninflammatory (clear and viscous), the joint is injected with a 2- to 4-mL mixture of 20 mg triamcinolone acetonide (or equivalent) and local anesthetic (Fig. 67-50).
FIGURE 67-50. Hip joint injection. Approach for hip joint aspiration and injection. Lateral approach.
The hip joint is difficult to aspirate or inject due to the depth and limited landmarks. Fluoroscopic guidance with the use of contrast media is recommended. It is rare to aspirate fluid from this joint.
Avascular necrosis of the hip has been reported as a result of repeated intraarticular injection of corticosteroids. Hematoma and intravascular injection are possible, owing to the close proximity of the femoral vessels. If an arterial puncture occurs, prolonged direct pressure is usually adequate to prevent the development of a hematoma. Corticosteroids should not be injected if there is any suspicion that the joint is infected. If the fluid appears infected, it should be sent for culture and sensitivity and the patient treated appropriately for the infection.