Patients with clinical and radiographic evidence of intra-articular hip pathology can benefit from non-image-guided diagnostic hip injections. This is a critical finding from a new study, which was co-authored by board certified orthopedic surgeon Dr. Tigran Garabekyan of the Southern California Hip Institute (SCHI).
Objective of the Study
The objective of this study was to determine the likelihood of pain relief, as a measure of accurate diagnosis of intra-articular hip pathology and correct needle placement, with a non-image-guided intra-articular hip injection performed bedside in the clinic.
While previous studies have demonstrated significantly improved accuracy, pain, and functional outcomes for image-guided versus palpation-guided injections, knee, shoulder and elbow joints, these image-guided injections present two challenges:
- Increased cost to patients
- Time lost between presentation and established diagnosis
The current non-image-guided technique addresses both these parameters.
Pain Relief in 98.7% of Cases
During the study period, 809 injections were performed in an office setting. The final study cohort comprised 142 patients (161 hips), of whom 120 hips (74.5%) were female.
Mean patient age was 38.8 years. In three cases, patients were unable to assess or quantify any change in overall pain level following the injection. In the remaining 158 hip injections, pain relief was noted in 156 cases (156/158, 98.7%), with at least 70% improvement in pain level noted in 152 cases (152/158, 96.2%). No post-injection hematomas occurred in the group.
Majority of Patients Experienced 90-100% Pain Relief
Based on the results of this study, non-image-guided intra-articular hip injections can provide substantial pain relief to the majority of patients who had clinical and radiographic evidence of intra-articular hip pathology.
This bedside technique, unencumbered by use of an image guidance, may be used to endorse suspected intra-articular pathology or provide short-term treatment with the inclusion of steroid medication.
In the present study, the average pain relief experienced by all patients was 89%, with the majority of patients experiencing 90–100% pain relief. Lack of complete pain relief after an intra-articular injection of lidocaine may be related to extra-capsular and surrounding musculature inflammation resulting directly or indirectly from the intra-articular pathology.
All six patients who reported less than 70% improvement in their pain following a non-image-guided hip injection were later confirmed to have an extra-articular pain source, thereby explaining the incomplete pain relief experienced by these patients.
Other Benefits of Non-Image-Guided Hip Injections
The non-image-guided hip injections performed in this study were well- tolerated by patients after a local anesthetic injection of lidocaine. These injections provide convenience to patients who present with joint or periarticular pain.
Patients may undergo a full assessment (with physical examination and radiographic imaging) and get confirmation of the cause of their pain during one visit with the use of diagnostic local anesthetic injections.
Furthermore, in patients who do not experience pain relief with a diagnostic hip injection, the provider can immediately prepare for further evaluation or diagnostic tests rather than delaying this process by several days or even weeks.
In many cases, this can yield significant savings in both time and monetary cost for patients. When these injections are performed by a radiologist, it is much more difficult for the patient to remember the efficacy of the injection by the time the patient follows up with the surgeon.
For team physicians, non-image-guided intra-articular injections may provide quick and temporary pain relief to allow immediate return to play for athletes.
Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:
Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.
Also visit http://www.drgorthopedics.com/