Can a posterior approach be used for hip steroid injection?

Hip Steroid Injection: Posterior Approach Safety and Efficacy

Yes, a posterior approach can be safely used for hip steroid injection and is supported by current evidence and clinical guidelines.

Anatomical Considerations for Hip Injections

The hip joint can be accessed through several approaches for steroid injections:

• Anterior approach: Most commonly used
• Anterolateral approach: Alternative common approach
• Posterior approach: Valid option with specific advantages

Posterior Approach Specifics

The posterior approach targets the posterior lateral aspect of the hip joint, which is included in recommended injection sites according to multiple guidelines 1. This approach accesses the joint through the posterior lateral aspect of both upper buttocks and flanks.

Evidence Supporting Posterior Approach

The American Academy of Orthopaedic Surgeons (AAOS) 2022 guidelines specifically mention the posterior approach as a valid surgical approach for hip procedures 1. While these guidelines primarily discuss surgical approaches for hip arthroplasty, they establish the safety and anatomical feasibility of accessing the hip joint posteriorly.

Current evidence does not show a difference in outcomes based on surgical approach, regardless of whether a direct anterior, lateral, or posterior approach is used 1. This principle can be reasonably extended to injection approaches as well.

Technique for Posterior Hip Injection

When performing a posterior hip injection:

1. Position the patient in lateral decubitus position with the affected hip up
2. Use imaging guidance (fluoroscopy or ultrasound) for accurate needle placement
3. Target the posterior lateral aspect of the hip joint
4. Use strict aseptic technique to minimize infection risk 2

Efficacy of Hip Steroid Injections

Hip steroid injections have demonstrated efficacy regardless of approach:

• Significant pain reduction at 3 and 12 weeks post-injection 3
• Improved range of motion in all directions 3
• Enhanced functional ability 3

A systematic review found that hip injections were effective in treating both short-term and long-term pain and were more effective than hyaluronic acid, mepivacaine, NSAIDs, and normal saline in terms of improvement in pain and/or function 4.

Patient Selection Considerations

Older patients with higher grades of radiographic osteoarthritis and high baseline pain are good candidates for steroid injections 5. This is particularly true for patients awaiting hip arthroplasty.

Safety Considerations

When using a posterior approach for hip steroid injection:

• Always use imaging guidance (fluoroscopy or ultrasound) to ensure accurate placement
• Employ strict aseptic technique to minimize infection risk
• Be aware of nearby neurovascular structures
• Consider the depth of injection to avoid intramuscular placement

A retrospective analysis found no cases of deep joint sepsis when using a strict aseptic technique for hip injections followed by later total hip replacement 2.

Conclusion

The posterior approach is a valid option for hip steroid injections with evidence supporting its safety and efficacy. The choice of approach should be based on the clinician's experience and patient-specific factors, but there is no evidence suggesting the posterior approach is inferior to other approaches for hip steroid injections.