Ultrasound-guided hip joint injection

Ultrasound Guided Hip Joint Injections

Ultrasound and Ultrasound-guided intra-articular injection are regularly being used in the diagnosis and treatment of a variety of painful hip disorders.

Musculoskeletal ultrasound is an essential tool for diagnosing hip musculoskeletal conditions, complementary to history and examination in the clinical assessment of hip problems. Guided injections offer great therapeutic value in the conservative management of symptomatic disorders.

What is the hip?

The hip joint is the articulation of the pelvis with the femur, which connects the axial skeleton with the lower extremity.

The hip joint comprises the femur and the acetabulum. The acetabulum is the socket on each side of the lower lateral parts of the pelvis where the femur is connected.

The hip is one of the most stable joints in the body. But because it bears your body weight, it is more likely to develop arthritis because of the extra pressure. Pain in the hip may be caused by injury to muscles, tendons, or the small fluid-filled sacs (bursae) that cushion and lubricate joints.

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What are the most common hip conditions causing pain?

The most common causes of the hip are arthritis and bursitis.

What is arthritis?

Arthritis is inflammation and pain in the hip joint. Arthritis affects around 10 million people in the UK, and sufferers can include children.

The two most prevalent kinds of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis

The most prevalent kind of arthritis in the UK, affecting approximately 9 million individuals, is osteoarthritis. It mostly affects those in their mid-40s or older.

Osteoarthritis is wear and tear of the smooth cartilage that lines the joint is initially impacted by osteoarthritis, resulting in discomfort, stiffness and reduced range of movement.

The tendons and ligaments must work harder when the cartilage lining begins to deteriorate and become rougher.

Rheumatoid arthritis

Rheumatoid arthritis affects around 400,000 persons in the UK. Women are three times more likely to be afflicted than males, and it frequently begins in people between the ages of 40 and 50.

The immune system of the body attacks the affected joints, causing discomfort and swelling. The first area to be impacted is the joint’s synovium, or outer coating. This may then spread throughout the joint, causing more swelling and a change in the form of the joint. The bone and cartilage could deteriorate as a result of this. Rheumatoid arthritis patients may also experience complications with various body organs and tissues.

Bursitis

In bursitis, the fluid-filled sac (bursa) in the joint becomes inflamed. The bursa functions as a gliding surface to reduce friction between tissues. There are two major bursae of the hip.

Both can cause stiffness and pain around the hip joint:

  • Trochanteric bursa. The bursa is on the side of the hip and separated from the actual hip joint by tissue and bone.
  • Iliopsoas bursa. The bursa in the upper buttock area.

Treatments for Hip Arthritis

The management of the symptoms of osteoarthritis includes the following treatment options:

  • Lifestyle modifications such as weight loss and exercise
  • Pain medications
  • Intra-articular hip injections – deliver local drug delivery by intra-articular (IA) injection to relieve joint pain.
  • Surgery such as hip replacement

Hip Injections

Hip injections can be blind or ultrasound-guided injections. There are several intra-articular medications, such as:

Steroids

Steroid injections such as hydrocortisone can offer pain relief and, when given appropriately, are generally very safe and cause very few side effects.

When steroid injections are more beneficial?

Corticosteroids are synthetic drugs that resemble cortisol, a hormone that you produce in your adrenal glands. Corticosteroids have powerful anti-inflammatory effects. As a rule, steroid injections are most useful for conditions where the pain caused by a musculoskeletal condition is a dominating feature and where there is a big impact on functional activities. Injections allow for an optimum dosage to a specific area of the body. Steroid injections tend to give pain relief relatively quickly, usually within one week following administration.

Hyaluronic acid injections

Hyaluronic acid injections are also called viscosupplementation injections. Hyaluronic acid injections are most commonly used to treat symptoms of knee osteoarthritis rather than hip. Hyaluronic acid is an important component of the joint fluid in healthy joints, but is found in lower concentrations in osteoarthritic joints. By adding hyaluronic acid to the existing joint fluid, the aim is to facilitate better joint movement, reduce pain and maybe slow down the progression of osteoarthritis.

When are hyaluronic injections used?

Often good candidates for visco-supplementation are those with osteoarthritis who have failed to improve with other non-surgical treatments, including steroid injections. Steroid injections can only be repeated a limited number of times due to their potential side effects. So regardless of the benefits of steroid injections, the hyaluronic acid injection might be a more suitable alternative in these circumstances.

Generally, people who benefit from hyaluronic acid injections are active people for whom good movement in their joints is important. They should not be used in acute, severe pain, as hyaluronic acid does not have the strong anti-inflammatory effects of a steroid injection and, therefore, might not provide enough hip pain relief in these more acute states.

Hyaluronic acid gives the joint fluid its viscous, slippery quality, which enables the bones’ cartilage-covered surfaces to glide against each other, thereby reducing joint friction. It adds cushion to protect joints during impact (e.g. weight-bearing activity).

Osteoarthritic joints have lower concentrations of hyaluronic acid in their joint fluid than healthy joints and therefore have less protection against joint friction and impact.

By injecting synthetically made hyaluronic acid into the knee, the aim is to lubricate the knee joint temporarily, thereby decreasing pain improving function and hopefully slowing the degeneration process.

Hydrodistention Injections

Hydrodistension or High Volume injections are performed under ultrasound guidance to precisely deposit anti-inflammatory steroids, local anaesthetic and saline to give pain relief whilst also deliberately stretching the lining of the joint (joint capsule). These injections can give a rapid and effective reduction in pain and inflammation; however, improvements are usually temporary. As with all medicines, some people may experience side effects.

References:

Lee, D.H., Yoon, S.H., Lee, M.Y., Kwack, K.S. and Rah, U.W., 2017. Capsule-Preserving Hydrodilatation With Corticosteroid Versus Corticosteroid Injection Alone in Refractory Adhesive Capsulitis of Shoulder: A Randomized Controlled Trial. Archives of physical medicine and rehabilitation, 98(5), pp.815-821.

Sharma, S.P., Bærheim, A., Moe-Nilssen, R. and Kvåle, A., 2016. Adhesive capsulitis of the shoulder, treatment with corticosteroid, corticosteroid with distension or treatment-as-usual; a randomised controlled trial in primary care. BMC musculoskeletal disorders, 17(1), p.232.

Yoon, J.P., Chung, S.W., Kim, J.E., Kim, H.S., Lee, H.J., Jeong, W.J., Oh, K.S., Lee, D.O., Seo, A. and Kim, Y., 2016. Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial. Journal of shoulder and elbow surgery, 25(3), pp.376-383.

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