Hip anesthetic arthrogram injection (fluoroscopic guided)

Q: Will you use extension tubing for the procedure? show answer

A: Its use can mean the practitioner's hands are out of the x-ray beam when injecting the hip.

Q: If the patient was allergic to iodinated contrast what could you suggest? show answer

A: Perform the procedure under ultrasound. Injectate is given under direct visualisation and no iodinated contrast is required.

Q: What do the images show? show answer

A: The first image shows evidence of osteoarthritis in the weight-bearing aspect of the hip joint. The radiopaque metal marker is used to help guide the marking of the skin entry point. The image stack shows the injection of iodinated contrast and confirms an intra-articular needle position.

Q: Would you use lidocaine before using the 22G needle to reach the joint? show answer

A: Injecting lidocaine with a smaller gauge needle, i.e. 25G, before using the larger 22G needle can make the procedure more comfortable. However injecting lidocaine into the superficial soft tissues can be uncomfortable itself, so if used it should be injected slowly.

Q: Does the administration of injectate remain inside the joint capsule? show answer

A: Yes, the injectate flows in an expected direction into the joint capsule and distends the joint.

Q: Why is the injectate radiolucent? show answer

A: The anesthetic arthrogram injectate did not contain iodinated contrast, therefore, diluting the existing contrast inside the joint.