Hip arthrogram injections (fluoroscopy)

Playlist contributed by Dai Roberts
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Hip arthrogram injections can be performed with fluoroscopy for both MRI arthrograms and anaesthetic arthrograms, and the ability to confirm that the needle tip is in the correct position is key.  This 10 case playlist covers some of the essential aspects required for performing these injections with questions included throughout the playlist. 

Playlist objectives

By the end of the playlist, the participant will be able to - 

  • identify the normal distribution of intra-articular iodinated contrast in fluoroscopic guided hip arthrogram injections
  • state how to position a patient for hip arthrogram injections
  • state the equipment required for both MRI and anaesthetic arthrogram injections
  • recognise extra-articular hip injections

Recommended time to complete: 20 minutes

Special thanks to Dr. Darra Murphy and Dr. Mark Cresswell for their teaching at St Pauls Hospital, Vancouver.

Summary

  • an intra-articular injection should easily flow and most commonly will distend the head neck portion of the hip joint
  • different needle approaches are used in arthrogram injections, aim to get experience in each and decide your preference
  • injections of contrast which have a linear distribution usually indicate an extra-articular injection and won't inject without resistance
  • know your equipment and needle sizes, one size does not fit all
  • injections under ultrasound-guidance are an excellent alternative

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