Overview of Hip Joint Injection
Hip pain is a common issue, especially in adults over the age of 60, with 12 to 15 percent experiencing it. It’s even more prevalent in people over 45 years old, with 27% suffering from hip osteoarthritis as evident in X-ray scans. In fact, those who are over 85 have a 25% chance in their lifetime of getting hip osteoarthritis, and 10% will probably need a total hip replacement at some point.
Osteoarthritis in the hip is a troubling condition which gradually causes the loss of protective cartilage in the joint. This can lead to the development of other painful conditions, like subchondral cysts (fluid-filled sacs in the joint), osteophyte formation (the creation of bony growths also known as bone spurs), and synovial inflammation (swelling in the protective fluid in the joints).
One of the prominent non-surgical treatments of hip pain is therapeutic hip joint injection. This treatment uses substances like corticosteroids (anti-inflammatory medicine), hyaluronic acid (a substance found naturally in joints that helps lubricate and cushion them), and plasma-rich platelets (proteins in the blood that help with healing).
When you get a fluoroscopic guided hip joint injection (an injection guided by a special kind of real-time X-ray), the main goals are to diminish the pain you’re experiencing, ensure your safety during the procedure, and use proper needle technique to access the space within the joint.
Anatomy and Physiology of Hip Joint Injection
The hip joint is where the top of the thigh bone, or femur, meets the pelvis in a cavity called the acetabulum. This joint is designed like a ball and socket and is surrounded by ligaments that make it sturdy. The unique structure of this joint allows us to do many things, like walking smoothly, standing from a sitting position, or moving around easily.
The pelvis is made up of three bones: the ilium, the pubis, and the ischium. Together, they create the acetabulum, the socket where the femur fits. At any given time, about 40% of the tip of the femur is covered by the acetabulum. A special structure made from collagen fibers, called the labrum, provides extra stability here.
Additional strength is added to the hip joint by three ligaments – the pubofemoral, ischiofemoral, and iliofemoral. These ligaments create a joint capsule that provides more stability to this area.
Osteoarthritis of the hip is a condition where the cushioning in the hip joint – the articular cartilage – starts wearing away. It’s not just the cartilage, but the bone beneath it and the ligaments and joint lining, or synovium, are also gradually affected. While the exact cause of osteoarthritis is complex and not fully understood, it’s thought to develop because of several factors. These include mechanical and environmental factors, as well as simply the result of the joint wearing down over time.
Why do People Need Hip Joint Injection
If a person is experiencing hip pain, certain procedures may be needed. These procedures can include:
– Lessening the pain
– Performing tests to figure out what’s causing the pain
– Removing fluid from the joint, which can relieve pressure and help with diagnosis
When a Person Should Avoid Hip Joint Injection
You should avoid certain treatments or procedures for your safety in some situations. Here are some examples:
Septic arthritis will prevent you from undergoing certain treatments. Septic arthritis is when a joint becomes infected by bacteria.
Cellulitis is a bacterial skin infection that takes place near the spot where the injection needle would go. This condition can make it risky for you to receive injections.
Bacteremia, an infection that spreads through the bloodstream, is another situation where using a needle might be unsafe.
An acute fracture, which is a broken bone that just happened, could also make certain procedures too risky.
Lastly, allergic reactions, also known as anaphylaxis, to the medicine that would be injected. This means that the medicine could potentially trigger a severe, life-threatening allergic response in your body.
Equipment used for Hip Joint Injection
Each clinic, hospital, or doctor may use different types of equipment for medical procedures. They may also use different amounts of medicine. In this section, we’ll go over some of the tools and medications that could be used for a procedure known as femoroacetabular joint injection.
This procedure could need the following equipment:
- A fenestrated drape or towel drapes: these are used to keep the area clean.
- A fluoroscopy machine: this machine helps your doctor see inside your body to guide the needle.
- 1 milliliter (mL) to 3 mL of 1% lidocaine hydrochloride: This is a local anesthesia that helps numb the area where the procedure will be done.
- A 23-gauge spinal needle: This is the needle they’ll use for the injection.
- 2 mL to 4 mL of iodinated contrast: This is a special dye that can help your doctor see the area better on an X-ray or other imaging machine.
- For corticosteroid injections: These are usually given to reduce inflammation or swelling. The mixture is about 3 mL and contains 1% lidocaine (2 mL) and triamcinolone 40 mg/mL (1 mL). Lidocaine helps numb the injection area, and triamcinolone is a type of steroid that helps reduce inflammation.
Who is needed to perform Hip Joint Injection?
The team involved in your care includes a medical professional who will give you the injection and a trained technician who knows how to use a special X-ray machine called a fluoroscopy. The fluoroscopy allows the doctors to see inside your body in real-time.
Preparing for Hip Joint Injection
Before undergoing a medical procedure using fluoroscopy (a type of imaging that shows a continuous x-ray image on a monitor), the doctor will have a detailed discussion with you. They’ll explain what will happen during the procedure, how much discomfort you might feel, and examine the area where they’ll insert the needle into your skin. They’ll also discuss any previous health conditions or surgeries that could affect the procedure, such as a joint prosthesis. Lastly, they’ll talk about what kinds of health issues they might find during the procedure and what complications could possibly occur.
Everyone involved in the procedure, including you, will wear a protective lead apron to shield against the x-rays. You’ll then lie down comfortably on your back. Your lower legs will be positioned straight or slightly turned inward about 10 degrees. Small weights may be used to keep your feet still and in the right position. The doctor will use the fluoroscopic image like an x-ray video to decide the best route for the needle. Lastly, they’ll mark the exact spot on your skin where they’ll insert the needle.
How is Hip Joint Injection performed
The doctor will start by marking the skin where the procedure will be done. Then, a local anesthetic, a type of medicine that numbs a specific part of your body, will be applied to the soft tissues beneath your skin. They use between 1 to 3 mL of this medicine, known as 1% lidocaine hydrochloride, to help you not feel any pain.
Next, the doctor will take a thin, long needle (a 23-gauge 3.5-inch spinal needle) and insert it into the marked area. They do this through the soft tissues until they reach the junction of the head and neck of the femur, or your thigh bone.
To ensure that the needle is placed correctly, the doctor will also use a tool called fluoroscopy. Fluoroscopy is a type of imaging technique that allows the doctor to see the inside of your body in real-time and ensure the needle is going in the right direction. They will also slightly pull back the needle to avoid touching the smooth, glossy part of the femur (the hyaline cartilage).
After this, they will remove the inner part of the needle (the stylet) and inject a small amount of anesthetic. This acts to numb the joint space and the surface of the bone beneath the cartilage.
The doctor will then inject a test contrast, which is a special dye that helps to make certain areas more visible during an imaging scan. This is done to make sure that the needle hasn’t ended up in a bursa, which are small, fluid-filled sacs near your joints, and is actually inside the joint.
Lastly, a syringe containing the corticosteroid, which is a type of medication that reduces inflammation, is attached to the thin needle that has already been placed. The corticosteroid is then injected into the joint to help with your treatment.
Possible Complications of Hip Joint Injection
Side effects after this procedure are not common, but they can happen. You might experience:
* An increase in the pain you normally feel, particularly the night right after the procedure. This could be due to a condition called bland synovitis, which is a type of joint inflammation.
* An allergic reaction.
* Injury to small blood vessels.
It’s also important for your doctor to check your previous medical images. This will help them to spot any unusual or individual aspects of your body’s internal structure.
What Else Should I Know About Hip Joint Injection?
Hip pain is a common issue, especially among people aged 65 and above, affecting about 19% of this age group. In fact, it’s estimated that 27 million people experience hip pain. This can significantly impact quality of life as it often stems from inflammation caused by conditions like arthritis related to aging and injuries. This could lead to both short-term and chronic pain in the hip joint.
Risk factors contributing to hip pain include older age, obesity, genetics, and jobs that involve a lot of heavy lifting or high-impact activities.
Various treatments can help alleviate hip pain without having to take medication. Performing low-impact exercises, like water workouts, can be beneficial. Physical therapy is often recommended for early stages of arthritis. Other helpful strategies include losing weight, applying heat or cold to the affected area, and using assistive devices like crutches to reduce the pressure on your hip.
There are also treatments that involve injecting specific substances into the hip joint. These injections can provide short-term pain relief and are often used in addition to the aforementioned strategies. These injections can include hyaluronic acids, corticosteroids, and platelet-rich plasma, which is a substance made from your own blood to promote healing. A 2016 study found that corticosteroid injections in the hip joint can effectively relieve pain short-term for arthritis patients.
The effects of hyaluronic acid and platelet-rich plasma are still being studied, but they seem to generally be effective. Injections are often guided by fluoroscopy, a kind of X-ray, to ensure accurate placement and prevent harm to important hip structures.