Hip arthrogram injection (fluoroscopic guided)

Q: How would you position a patient for a hip arthrogram injection under fluoroscopy? show answer

A: Small bean bag/ bolster under the knee and internal rotation of the leg (foot) with the placement of a further bean bag on the lateral aspect of the foot to maintain an internally rotated position. Slight knee flexion takes tension off the hip joint and the internal rotation of the leg medially displaces the neurovascular structures.

Q: What are the important points to discuss during the consent process for an anaesthetic arthrogram injection? show answer

A: Risk of infection, bleeding, and allergy to injectate. Some experience a 'steroid flare' after a corticosteroid containing injection but it will settle after a few days. A good response to the injection is 12-18 months.

Q: What type and size of needles are typically used for hip arthrograms? show answer

A: 22G Quincke needle (commonly known as spinal needles) are frequently used. A common needle length is 4.5 inches/ 90mm which offer a reasonable length to reach the joint. An oblique course as demonstrated, increases the distance from the skin to joint and this should be taken into account when planning and assessing the angle of entry.

Q: Is the injection of iodinated contrast intra-articular? show answer

A: Yes, the injection of iodinated contrast is freely flowing in an expected intra-articular course.

Q: Describe your findings. show answer

A: Evidence of distension of the hip joint in an expected fashion as more injectate is given. The needle remains in situ.