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

Abstract

The purpose of this study was to determine the likelihood of pain relief, as a measure of accurate diagnosis of intra-articular hip pathology and correct needle placement, with a non-image-guided intra-articular hip injection performed bedside in the clinic. A retrospective study of prospectively collected data was performed in a consecutive cohort of patients diagnosed with symptomatic intra-articular hip pathology who underwent a non-image-guided intra-articular injection in the clinic. All patients had clinical and radiographic evidence of hip impingement, hip instability, chondrolabral pathology, or other causes of intra-articular hip pain. A previously described technique for a non-image-guided hip injection was performed using 7–10 ml of 1% lidocaine for diagnostic evaluation with some patients receiving 2 ml of Kenalog®-40 if clinically indicated. Ten minutes following each injection, the patient was asked to report the percent improvement in pain (from 0 to 100%) while physical examination and provocative tests were repeated. The final study cohort comprised 142 patients (161 injections). In three cases, patients were either unable to assess or quantify any change in pain level 10 min following the injection. In the remaining 158 hip injections, pain relief was noted in 156 cases (156/158, 98.7%), with at least 70% improvement in pain level noted in 152 cases (152/158, 96.2%). Average pain relief among all 158 injections was 89 ± 16%. A non-image-guided diagnostic intra-articular hip injection yields reliable short-term pain relief, simultaneously endorsing accurate diagnosis of hip pathology and intra-articular needle placement.

Comparing Intra-articular Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Low–Molecular Weight Hyaluronic Acid for the Treatment of Symptomatic Osteoarthritis of the Hip: A Double-Blind, Randomized Pilot Study

“…Non–image guided intra-articular hip injections were given based on anatomic landmarks as previously described. 22 , 30 In a previous study using this same technique, we found that 96% of patients with intra-articular hip abnormalities experienced at least 70% improvement in pain after a corticosteroid injection, thereby proving the efficacy of the non–image guided technique. 22 Patients were advised to significantly reduce physical activity for 2 to 3 days after each injection and were instructed to avoid blood-thinning medications 2 days before and 5 days after the injections, including aspirin and NSAIDs.…”

Statistically based nomograms for the minimal needle length required to achieve intra‐articular fluoroscopic‐guided injections of the shoulder, hip, and knee

“…One of the most common nonsurgical methods for the treatment of osteoarthritis includes pain‐related interventions such as intra‐articular injection of platelet‐rich plasma, hyaluronic acid, and analgesic agents often in combination with corticosteroids 15,16 . Intra‐articular injections may be image guided (usually ultrasound or fluoroscopic) or non‐image guided when performed in the office; however, most reports suggest that image‐guided intra‐articular injections are more accurate 17–22 …”

“…15,16 Intra-articular injections may be image guided (usually ultrasound or fluoroscopic) or non-image guided when performed in the office; however, most reports suggest that image-guided intraarticular injections are more accurate. [17][18][19][20][21][22] The hip, knee, and glenohumeral joints are large joints, and as a result, the distance from the skin to the joint may be affected by patient habitus and obesity. A patient may need to have a repeated needle stick with a needle of the appropriate length if the original needle used was too short to achieve an intra-articular injection even with compression of the soft tissues.…”

Risk of Infection in Knee Arthroscopy Patients Undergoing Corticosteroid Injections in the Perioperative Period

“…2,5 The potent anti-inflammatory properties of corticosteroids are effective in relieving pain secondary to intra-articular pathology, 26 reducing postoperative analgesic consumption and pain scores, 13,20 and elucidating the origin of knee pain for clinical decision-making purposes. 15 However, there is some concern that corticosteroids suppress the intra-articular immune response, making the joint vulnerable to postoperative infection. 29 , 30 The increased risk of infection after preoperative CSI has been validated in the arthroplasty literature.…”