Is an intraarticular hip joint injection easier with internal or external rotation of the hip?

From the Guidelines

Internal rotation of the hip, approximately 15° to 20°, is the preferred position for intraarticular hip joint injections, as it allows for better alignment of the femoral neck and facilitates accurate needle placement. This positioning is crucial in minimizing the risk of complications and ensuring the success of the procedure.

Key Considerations

• The patient's legs should be straight and parallel, with the toes pointing upwards, to maintain proper alignment and reduce movement during the procedure 1.
• The femoral neck should be centered in the scan field, and the lesser trochanter may be visible, to confirm adequate internal rotation 1.
• A positioning device for the feet, secured with a strap, can be used to achieve and maintain the desired degree of internal rotation, ensuring that the leg remains still during the acquisition 1.

Clinical Implications

• Internal rotation of the hip helps to position the femoral neck parallel to the scan table plane, making it easier to access the joint space and reducing the risk of vascular injury 1.
• This positioning also relaxes the surrounding soft tissues, allowing for a more comfortable and successful procedure.
• The use of fluoroscopic or ultrasound guidance, in conjunction with internal rotation, can further enhance the accuracy and safety of intraarticular hip joint injections.

From the Research

Intraarticular Hip Joint Injection

• The ease of intraarticular hip joint injection with internal or external rotation of the hip is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, a study on intra-articular hip injection using anatomical and radiological landmarks without the use of ultrasound or radiological guidance found that the technique was safe and accurate in 94.3% of patients 4.
• The study used a combination of radiographic and anatomic landmarks, including the anterior superior iliac spine (ASIS), the cephalic, and caudal femoral head-neck junctions, to determine the injection location.
• Another study found that intra-articular corticosteroid injections to the hip were safe, with a low risk of septic arthritis, rapidly progressive osteoarthritis, and periprosthetic joint infections 5.
• The safety and efficacy of intra-articular hip injections may depend on various factors, including the medication used, the technique, and the patient's condition 2, 3, 6.
• A systematic review of intra-articular hip injections for osteoarthritis found that platelet-rich plasma injections seemed to decrease pain and disability in patients with hip osteoarthritis, while the association of hyaluronic acid and corticosteroids may give better results compared to hyaluronic acid alone 6.

Technique and Safety

• The technique used for intra-articular hip injection can affect the accuracy and safety of the procedure 4.
• The use of anatomical and radiological landmarks can help improve the accuracy of the injection 4.
• Sterile techniques and proper patient selection are crucial to minimize the risk of complications, such as septic arthritis and periprosthetic joint infections 5.

Medications and Efficacy

• Different medications, including corticosteroids, hyaluronic acid, and platelet-rich plasma, can be used for intra-articular hip injections, with varying levels of evidence-based efficacy 2, 3, 6.
• The choice of medication and technique may depend on the patient's condition, the severity of osteoarthritis, and the desired outcome 2, 3, 6.