What are the comprehensive instructions for an ultrasound-guided hip injection procedure?

From the Guidelines

Ultrasound-guided hip injection is a precise procedure that requires real-time ultrasound visualization to deliver medication directly into the hip joint, and it is strongly recommended to use ultrasound guidance for intraarticular glucocorticoid injection into hip joints, as stated in the 2019 American College of Rheumatology guideline 1. To perform the procedure, begin by positioning the patient supine with the hip in slight internal rotation. Prepare the injection site using sterile technique with chlorhexidine or povidone-iodine solution and drape the area.

• Use a high-frequency linear transducer (6-12 MHz) covered with a sterile sleeve, as maintaining probe and cable sterility is crucial to prevent infections 1.
• Identify key landmarks including the femoral head, neck, and acetabulum using an anterior approach.
• After administering local anesthesia (1-2 mL of 1% lidocaine) to the skin and subcutaneous tissues, insert a 22-gauge, 3.5-inch spinal needle using an in-plane technique, directing it toward the femoral head-neck junction.
• Confirm proper needle placement by injecting a small amount of contrast under fluoroscopy if available. The typical injectate consists of a corticosteroid (40 mg methylprednisolone or 40 mg triamcinolone) mixed with 4-5 mL of 0.5% bupivacaine or 1% lidocaine.
• Inject slowly while monitoring for resistance. After injection, remove the needle, apply pressure briefly, and place a sterile bandage.
• Advise the patient to rest for 24-48 hours, avoid strenuous activities for several days, and watch for potential complications such as infection, bleeding, or temporary pain flare, as recommended by the EULAR guidelines for intra-articular therapies 1. This technique provides accurate medication delivery directly to the affected joint space, maximizing therapeutic effect while minimizing systemic absorption and complications.

From the Research

Ultrasound-Guided Hip Injection Procedure

The following are the comprehensive instructions for an ultrasound-guided hip injection procedure:

• Patient positioning: The patient is typically positioned supine for the injection procedure 2.
• Approach: An anterosuperior approach is used for the injection, with the ultrasound probe applied to guide the needle into the hip joint 2.
• Guidance: Ultrasound guidance is used to ensure accurate placement of the needle and injection of the medication into the joint space 3, 2, 4, 5.
• Medications: Various medications can be used for the injection, including corticosteroids, hyaluronic acid, and ketorolac 3, 2, 4, 5.
• Technique: The standardized technique involves using a target device for biopsy and injecting the medication under ultrasound guidance 2.
• Safety: The procedure is generally well-tolerated, with few and exclusively local side effects reported 2.

Key Considerations

• The use of ultrasound guidance can provide higher injection accuracy and repeatability compared to other methods 4.
• The procedure can be used to treat patients with symptomatic and radiographic hip osteoarthritis, and can delay the need for interventional surgery 4.
• Intra-articular ketorolac injection can be considered a useful alternative to corticosteroid injection for patients with contraindications to using corticosteroids 5.
• The effectiveness of the procedure can be evaluated using outcome measures such as the Harris hip score and verbal numeric pain scale 5.