What does the injection of iodinated contrast show?
The injection confirms the needle is in an intra-articular position. Contrast extends into the superolateral and anterior aspects of the head neck portion of the hip joint.
Is tubing attached to the needle for the injection of iodinated contrast?
Yes and tubing will mean the practitioners hand(s) are not in the path of the x-ray beam. The tubing should be primed with fluid before injecting the joint, to minimise gas bubbles within the joint. Although less important in anaesthetic arthrograms it is important in MRI arthrogram injections, as gas bubbles can look like intra-articular bodies on MRI. It is good practice to always prime the tubing in all injections.
What should be considered before injecting the hyaluronic acid?
Removing the tubing as it is a dead space. Once an intra-articular position has been confirmed with contrast the tubing is often removed in these injections all the hyaluronic acid should be injected into the hip. Consideration should also be given to the amount of fluid within the needle shaft itself and a small volume of gas could be injected to flush the needle at the end of injection.
With a 22G Quincke needle in situ, injection of iodinated contrast shows extension into the superolateral and anterior aspects of the head neck portion of the hip joint.