Should the hip be internally or externally rotated for an intra-articular (within a joint) hip joint injection?

From the Guidelines

For an intra-articular hip joint injection, the hip should be positioned in slight internal rotation, approximately 15-20 degrees, to facilitate better access to the joint space and minimize the risk of complications. This positioning is supported by the most recent guidelines, which emphasize the importance of proper positioning for accurate and safe procedures 1.

Key Considerations

• The patient should be placed in a supine position with the affected hip internally rotated to expose the anterior aspect of the femoral head and neck junction.
• Internal rotation stretches the anterior joint capsule and moves the femoral head slightly posteriorly, creating better visualization of the target area, especially when using image guidance such as fluoroscopy or ultrasound.
• The internal rotation also helps to move the femoral neurovascular bundle away from the injection site, reducing the risk of vascular or nerve injury.
• This position stabilizes the hip joint during the procedure, making it easier for the clinician to maintain accurate needle placement.

Procedure Details

• The femoral neck should be centered in the scan field, and the lesser trochanter may be visible.
• Scans should be acquired with a degree of internal rotation of the leg about 15° to 20°, which positions the femoral neck parallel to the scan table plane.
• Adequate internal rotation should be confirmed with barely visible detection of the lesser trochanter.
• The appropriate amount of internal rotation can be achieved using a positioning device for the feet, secured with a strap to avoid movement during the acquisition.

Clinical Implications

• Proper positioning is essential for successful delivery of medication into the joint space while minimizing complications.
• The use of image guidance, such as fluoroscopy or ultrasound, can further enhance the accuracy and safety of the procedure.
• Clinicians should prioritize proper positioning and technique to ensure optimal outcomes for patients undergoing intra-articular hip joint injections, as supported by the latest guidelines 1.

From the Research

Intra-Articular Hip Joint Injection Technique

The provided studies do not directly address whether the hip should be internally or externally rotated for an intra-articular hip joint injection. However, they do discuss various aspects of intra-articular hip injections, including techniques, efficacy, and outcomes.

Key Findings

• A study published in 2016 2 compared patient-reported outcomes and clinical efficiency between two US-guided intra-articular hip injection techniques, but did not mention hip rotation.
• Another study from 2006 3 described the technique for performing ultrasound-guided intra-articular hip injections in an office-based physiatric practice, without discussing hip rotation.
• A 2017 study 4 determined the accuracy of ultrasound-guided hip injections performed in the orthopedic clinic by orthopedic surgeons and orthopedic physician assistants, but did not address hip rotation.
• A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis published in 2022 5 discussed various injection agents and techniques, but did not mention hip rotation.
• A 2021 study 6 investigated the effectiveness of ultrasound-guided anesthetic intra-articular injection to estimate the outcome of hip arthroscopy in patients with femoroacetabular impingement syndrome, but did not discuss hip rotation.

Injection Techniques and Outcomes

• The studies suggest that ultrasound-guided intra-articular hip injections are accurate, efficient, and patient-friendly 4, 6.
• Intra-articular corticosteroid injections can provide significant improvements in pain and function for patients with intra-articular hip pain 2, 5.
• The choice of injection technique and agent may depend on various factors, including patient characteristics, diagnosis, and treatment goals 2, 5.