HIP JOINT ARTHROCENTESIS UNDER ULTRASOUND GUIDANCE

Abstract

The purpose of our presentation is to propose a asimple and reliable method which does not expose the doctor and the patient to radiation for hip arthrocentesis and to be used by inexperienced doctors as well as for studies.

Hip Arthrocentesis (HA) on every day practice is performed by the anatomic knowledge and experience. But as a study has shown there is a high failure rate as it concerns the correct position of the needle in the joint, even in joints as the knee and shoulder where the intraarticular injections as usual.

According to the American College of Rheumatology hip arthrocentesis should be performed by experienced Rheumatologists, Orthopaedic Surgeons and Radiologists, and always under radiological control.

HA at first has been performed for diagnostic purposes, mainly infections, for fluid aspiration. Later for therapeutic reasons (corticosteroids), and for the differential diagnosis between abdominal and osteoarthritic pain of the hip with the intraarticular injection of local anaesthetic.

HA under ultrasound control was initially performed in 1989 for diagnostic reasons and later in 2001 has been used for intraarticular injections of Hyalouronic Acid for the treatment of hip osteoarthritis.

In the international literature publications about the help that Ultrasonography provides at hip arthrocentesis are sporadic (sparse).

Since 2000 we performed 50 intraarticular injections at the hip joint in our out -patient department under ultrasonographic control for the confirmation of the correct position of the needle in the articulation. All patients suffered from hip osteoarthritis according to the criteria of the American College of Rheumatology, and all were female, 50 – 75 years old. 30 injections were performed with simple head (Convex) of 6 MHz and 20 with linear head of 9 MHz. There was no difference concerning the accuracy of needle placement, but a more clear picture had the linear head.

There was no complication.

In the Hellenic area, to our knowledge, this method is applied and announced for the first time.

In conclusion we believe that it is an accurate and safe method which does not expose neither the patient nor the doctor to radiation and is much less time – consuming than CT. it can be recommended for inexperienced collegues, for studies that need confirmation, as well as for control of the correct placement of the needle intraarticular for therapeutic purposes. In general it can be used for every hip arthrocentesis.