Do we need radiological guidance for intra-articular hip injections?

There is still a debate as to whether radiological guidance is needed for intra-articular hip injections. The aim of this study was to evaluate correct needle positioning for the hip joint performed with a non-radiological method and confirmed on arthrogram under image intensifier. Patients listed for diagnostic and therapeutic hip joint injections were included in our study. Eighty seven patients (100 hips) underwent injections with the non-radiological method using anatomical landmarks. Fluoroscopy and arthrogram were then used to confirm the needle position. The primary outcome measure was the success rate of correct positioning of the needle in hip joint by the non-radiological method, as confirmed on arthrogram under image intensifier. The secondary outcome measures were relationship between the grade of the surgeon and patient BMI to success rate of hip injections by the non-radiological method. Overall success rate with the non-radiological method was 67%. Consultants were 77.1% successful and registrars 57.7% (P = 0.039). The average body mass index (BMI) in the successful group was 28.45 (SD = 5.21) and 32.03 (SD = 4.84) in the unsuccessful group (p=0.001). Success was further improved to 88% when performed by a consultant in low BMI (< 30) patients. This prospective study shows that hip injections can be performed with reasonable success without radiological guidance. Experienced surgeons may be able to perform this procedure in outpatient clinics in normal BMI patients; thereby reducing costs and the need for bed space.