title: Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography.
abstract: Diraçoğlu D, Alptekin K, Dikici F, Balci HI, Ozçakar L, Aksoy C. Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography.
  
  
  OBJECTIVE
  To evaluate needle positioning during blind/anatomically referenced hip joint injections for osteoarthritis (OA).
  
  
  METHODS
  Experimental clinical study.
  
  
  METHODS
  Operating theater of a university hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey. demirhan1@yahoo.com
authors.forename: Demirhan
authors.initials: D
authors.lastname: Diraçoğlu
authors.forename: Kerem
authors.initials: K
authors.lastname: Alptekin
authors.forename: Fatih
authors.initials: F
authors.lastname: Dikici
authors.forename: Halil Ibrahim
authors.initials: HI
authors.lastname: Balci
authors.forename: Levent
authors.initials: L
authors.lastname: Ozçakar
authors.forename: Cihan
authors.initials: C
authors.lastname: Aksoy
mesh_terms: D001175:Arthrography; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007270:Injections, Intra-Articular / Q000379:methods*; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D009339:Needles; D015207:Osteoarthritis, Hip / Q000188:drug therapy*; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D003287:Contrast Media; D055675:Viscosupplements; D007472:Iohexol; D006820:Hyaluronic Acid