Hip anesthetic arthrogram injection (fluoroscopic guided)

Q: Are all hyaluronic acid preparations the same? show answer

A: No, some are combined with steroid in premixed syringes, therefore a knowledge of the different hyaluronic acid preparations and trade names is important before using.

Q: What does the injection of iodinated contrast show? show answer

A: 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.

Q: Is tubing attached to the needle for the injection of iodinated contrast? show answer

A: 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.

Q: What should be considered before injecting the hyaluronic acid? show answer

A: 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.

Q: Is all the injectate intra-articular? show answer

A: Yes, no evidence of an extra-articular injection.