Intra-Articular Injection of the Hip Joint—Lateral Approach

Indications and Clinical Considerations

The lateral approach to intra-articular hip injection provides an alternative approach to intra-articular injection of the hip for patients who have a large abdominal pannus that would make an anterior approach difficult. It is also useful in patients who have infections of the groin. The hip joint is susceptible to developing arthritis from a variety of conditions that all have the ability to damage the joint cartilage. Osteoarthritis of the joint is the most common form of arthritis that results in hip joint pain ( Fig. 121.1 ). However, rheumatoid arthritis and posttraumatic arthritis also are common causes of hip pain secondary to arthritis. Less common causes of arthritis-induced hip pain include the collagen vascular diseases, infection, villonodular synovitis, and Lyme disease. Acute infectious arthritis usually is accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized by the astute clinician and treated appropriately with culture and antibiotics rather than injection therapy. The collagen vascular diseases generally manifest as a polyarthropathy rather than a monoarthropathy limited to the hip joint, although hip pain secondary to collagen vascular disease responds exceedingly well to the intra-articular injection technique described later.

The majority of patients with hip pain secondary to osteoarthritis and posttraumatic arthritis pain report pain localized around the hip and upper leg. Activity makes the pain worse; rest and heat provide some relief. The pain is constant and is characterized as aching. The pain may interfere with sleep. Some patients note a grating or popping sensation with use of the joint, and crepitus may be present on physical examination.

In addition to the previously mentioned pain, patients with arthritis of the hip joint often experience a gradual decrease in functional ability with decreasing hip range of motion, making simple everyday tasks such as walking, climbing stairs, and getting in and out of cars quite difficult. With continued disuse, muscle wasting may occur and a “frozen hip” caused by adhesive capsulitis may develop.

Plain radiographs are indicated for all patients with hip pain. On the basis of the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging and/or ultrasound imaging of the hip is indicated if aseptic necrosis, occult mass, tumor, or other hip pathology is suspected ( Figs. 121.2, 121.3, and 121.4 ).