Hip joint injection

dr Albertus Sugeng Wibisono,SPAn, FIPM,FIPP

Indications
• Osteoarthritis
• Steroid
• Viscosuplement
• Prolotherapy
• Synovitis
• Aspiration
Hip joint: blood supply

Medial and lateral circumflex artery ( branches of Deep femoral artery)

HIP : innervation
• Anterior hip capsule
• Articular branch of obturator
nerve
• Accessory Obturator nerve
• Articular branch of femoral nerve
• Posterior hip capsule
• Branch of the superior gluteal
nerve and sciatic nerve
THE ANTERIOR SYNOVIAL RECESS (***)
Scanning : (lateral)
• Position : Supine
• Probe Curvelinear 2-6
MHz
• Operator stands on the
affected side of the
patient
• Probe perpendicular to
the femur at the upper
third of the thigh: femoral
shaft in short axis as a
dome shape hyperechoic
structure
Scanning
• Scan cephalad until
femoral bone is no
longer dome shaped,but
flattens out.
• The flat bone marks the
anterior surface of the
greater trochanter
Scanning
• Rotate the probe toward
the femoral neck and
head.
• Slide the probe toward
the femoral head to
optimize image to
visualize the femoral
neck, femoral head,
acetabulum, capsule and
anterior recess
Scan (medial)
• Transducer orientation :
oblique axial plane parallel to
inguinal ligament
• Landmark AIIS
• Place the cranial end of the
transducer in sagittal plane
medial AIIS, visualize the
acetabulum and femoral
head and slide distally
Scan Technique
• Rotate the caudal end of the
transducer obliquely, the axis of
the transducer parallel with the
femoral neck
• Transducer position anteriorly in
the oblique sagittal plane, along
with the femoral head-neck
angle
Before injecting, identify the Lateral femoral circumflex artery
between iliopsoas muscle and rectus femoris

RF
IP
Procedure
• Needles : 22 G, 3.5 – 5 inch
depending on patient size
• Drugs:
• 4 – 8 mL of local anesthetic (0.25%
plain bupivacaine). Mixed with 1 mL
depo steroid ( methyl prednisolone or
triamcinolone)
• 5 mL hyaluronic acid
• In plane approach
• Target: the anterior recess at the
junction of the femoral head and
femoral neck
Procedure
• Fluid spread under the hip
capsule
References
• Agnes Stogicza. Hip . in ultrasound for Interventional Pain
Management. Springer Nature Switzerland AG 2020
• Malanga GA. Atlas of Ultrasound-Guided Musculoskeletal Injections
• Philip W.H. Peng. Ultrasound-Guided Interventional Procedures in
Pain Medicine. A Review of Anatomy, Sonoanatomy, and Procedures.
Part IV: Hip
• Spinner DA. Atlas of Ultrasound Guided Musculoskeletal Injections