Accuracy of Ultrasound-Guided Intra-articular Hip Injections Performed in the Orthopedic Clinic

Abstract

Intra-articular hip injections have proven clinical value for both diagnostic and therapeutic purposes. Historically, these injections have been performed by radiologists using fluoroscopic guidance. This necessitates a radiology referral, delays the injection, and represents lost productivity for the orthopedist. Ultrasound-guided intra-articular hip injections have been described in the radiology literature with excellent accuracy. These injections were performed by radiologists. The purpose of this study was to determine the accuracy of ultrasound-guided hip injections performed in the orthopedic clinic by orthopedic surgeons and orthopedic physician assistants. Fifty ultrasound-guided hip injections were performed using a standard technique. Contrast was included, and an anteroposterior pelvis radiograph was obtained immediately following injection. Diagnosis, body mass index, procedure time, and visual analog scale scores were recorded. Radiographs were reviewed independently by a musculoskeletal radiologist and an orthopedic surgeon to determine intra-articular placement of the injection. A total of 50 hips were injected. There was no identifiable contrast in 2 patients, leaving 48 hips for analysis. Of these, contrast was injected intra-articularly in 46 hips for an accuracy of 96%. Average procedural time was 2.6 minutes, and the average visual analog scale score was 1.9 during the procedure. Revenue value units ranged from 1.72-2.55 for ultrasound-guided hip injections. These findings indicate ultrasound-guided intra-articular hip injections performed in the orthopedic clinic by surgeons or physician assistants are accurate, efficient, and patient-friendly. Additionally, they preserve patient continuity and maintain productivity within the orthopedic clinic. [Orthopedics. 2017; 40(2):96-100.].

Retrospective Analysis of the Accuracy of Ultrasound-Guided Magnetic Resonance Arthrogram Injections of the Hip in the Office Setting

“…As Otjen et al 12 noted in their study of US-guided joint injections for MR arthrography in pediatric patients, US is likely more technically challenging than fluoroscopy, requiring more dexterity because concomitant transducer and needle manipulation is needed. In our practice, we have experienced an expeditious learning curve for USguided hip injections, which is similar to that reported by Byrd et al 4 and Balog et al 2 While our data do not demonstrate a clearly defined significant decrease in filling defects over time, no instances of inappropriately placed contrast were reported in the final 10 months of the data collection period. In the hands of an experienced clinician, the US method is safe, reliable, and reproducible.…”

“…Byrd et al 4 reported on a large series of 206 hip injections performed by a nurse practitioner, achieving a 98% accuracy rate. More recently, Balog et al 2 reported a 96% accuracy rate for a series of 48 US-guided hip injections performed in an orthopaedic clinic by orthopaedic surgeons and orthopaedic physician assistants. Upon review of the data, the sole limiting variable to a successful MR arthrogram was inappropriately placed contrast, which led to a decreased volume of contrast within the hip capsule on imaging.…”

Current Variation in Joint Aspiration Practice for the Evaluation of Pediatric Septic Arthritis

“…In the current study, 94.4% of institutions reported using image guidance, with 50% using ultrasound and 44.4% fluoroscopy. Ultrasound guidance has been shown in adult patients to be safe and accurate for intra-articular placement 26 and has found growing utilization for the evaluation of the painful pediatric hip. 5 , 11 , 27 …”

Efficacy of a non-image-guided diagnostic hip injection in patients with clinical and radiographic evidence of intra-articular hip pathology

“…By using palpation of anatomic landmarks, these injections can achieve a high level of accuracy, be convenient and be cost-effective, allowing physicians to perform diagnostic and therapeutic injections in the clinic rather than referring the patient to a radiologist [ 4 ]. Intra-articular hip injections are typically performed using ultrasound or fluoroscopic guidance [ 5–8 ]. Ultrasound-guided hip injections may be performed in the orthopaedic clinic [ 5 ], though these injections are more commonly performed under fluoroscopy guidance by a radiologist, with confirmation provided by the intra-articular positioning of radiopaque contrast material [ 6 ].…”

“…Intra-articular hip injections are typically performed using ultrasound or fluoroscopic guidance [ 5–8 ]. Ultrasound-guided hip injections may be performed in the orthopaedic clinic [ 5 ], though these injections are more commonly performed under fluoroscopy guidance by a radiologist, with confirmation provided by the intra-articular positioning of radiopaque contrast material [ 6 ]. Recently, however, non-image-guided techniques have been described for the hip using anatomic landmarks and palpation [ 9–12 ].…”