Background In order to validate intra-articular medical treatment of osteoarthritis in the hip joints it is imperative to have documentation of the correct placement of the injection.
Radiographic methods imply a radiation load, while ultrasound (US) is harmless.
Objectives Our goal was to evaluate the use of US as guidance when performing injections in osteoarthritic hips using air as contrast medium.1–3
Methods A total of 30 injections were given to 11 Patients with hip-osteoarthritis (ACR criteria)(Mean age 60 years (Range 44–86)).
The femoral head and neck was scanned with a 8–13 MHz linear transducer.
The probe was placed below the inguinal ligament in parallel with the axis of the femoral neck.
Placement of a gauge 21 needle into the hip joint (anterior/inferior capsule below the femoral head) was monitored with a B mode (grey scale) scanning allowing a continuous visual guidance.
Preceding the treatment, a small (0,5–2 ml) amount of atmospheric air was injected.
Results The position of the needle was evident on the screen in all cases. The injections of air into the joint was demonstrated in 29 cases presenting a small hyperechoic brim inside the joint capsule. However, in one case in spite of a seemingly correct placement of the needle the hyperechoic air brim was clearly positioned outside the joint. Placement of the needle was subsequently corrected.
Still picture of the setting as documentation revealed the presence of air without difficulty, however the needle tended to be less recognisable when not in motion.
Conclusion The sole use of grey scale US as guidance device gives a good view of the intra-articular placement of a needle. However use of air as US contrast before an injection or aspiration, enhances the precision and allows photographic documentation of the set-up.
Carson BW, Wong A. Ultrasonographic guidance for injections of local steroids in the native hip. J Ultrasound Med. 1999;18(2):159–60
Bliddal H, Torp-Pedersen S. Use of small amounts of ultrasound guided air for injections. Ann Rheum Dis. 2000;59(12):926
Qvistgaard E, et al. Guidance by ultrasound of intra-articular injections of the knee and hip. submitted
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