Article

OBJECTIVE: To evaluate needle
positioning during blind/anatomically referenced hip joint injections for
osteoarthritis (OA). DESIGN: Experimental clinical study. SETTING: Operating
theater of a university hospital. PARTICIPANTS: Patients (N=16) (10 women, 6
men), who were diagnosed as having OA according to the American College of
Rheumatology criteria and whose radiologic grades were II or III according to
Kellgren-Lawrence. INTERVENTIONS: Three bilateral and 13 unilateral hip
injections were performed (3 times at 1-week intervals). After it was presumed
blindly that the needle was within the joint, the location of the needle was
checked with backflow technique and fluoroscopy. Entrance to the joint cavity was
also ensured by reconfirmation with contrast medium, and the procedure was then
terminated with hyaluronic acid injection. MAIN OUTCOME MEASURES: Assessment of
blind needle placement into the hip joint by using backflow technique,
fluoroscopic images, and contrast enhancement. RESULTS: The location of the
needle was fluoroscopically confirmed to be at the proper position in 38 (66.7%)
of the 57 blind interventions. Furthermore, in 29 (76.3%) of those 38
interventions, localization of the intra-articular needle could be confirmed by
intra-articular contrast uptake. Overall, 29 of 57 (50.9%) blind interventions
exhibited intra-articular contrast enhancement. Backflow was not observed in 23
(79.3%) of these 29 interventions. Five (17.9%) of 28 interventions with no contrast uptake showed backflow. CONCLUSIONS: In light of our results, we suggest
that blind injection of the osteoarthritic hip joint can be inaccurate even with
careful technique. Further, the backflow method does not appear to be reliable,
and guidance during the injection seems to be necessary.

Langue : ANGLAIS