title: An Anatomic Analysis of Mid-anterior and Anterolateral Approaches for Hip Arthrocentesis: A Male Cadaveric Study.
abstract: OBJECTIVE
  To determine the accuracy and safety of non-image-guided modified mid-anterior and anterolateral approaches to the hip joint for arthrocentesis.
  
  
  METHODS
  Six pairs (n = 12) of human cadaveric hemipelvises underwent methylene blue hip injections through either a mid-anterior or an anterolateral approach. The distance from the mid-anterior approach to the lateral femoral cutaneous nerve (LFCN) was measured. Needle orientation was defined by a combination of 2 angles, calculated by the computer software analysis of digitized points. Distal Angle was defined as the angle between the lateral axis and an intermediate needle position, in the coronal plane, toward the distal axis. Anterior Angle was defined as the angle between the intermediate needle position of Distal Angle and the final position, toward the anterior axis.
  
  
  RESULTS
  Methylene blue was successfully injected into the joint capsule in all specimens. The mean distances from the needle to the LFCN for both the mid-anterior and anterolateral approaches were 19.3 ± 7.9 and 80.3 ± 28.3 mm, respectively. For the mid-anterior approach, Distal AngleMwas a mean of 53.9° ± 14.9° and Anterior AngleMwas a mean of 33.4° ± 15.6°. For the anterolateral approach, Distal AngleLwas a mean of 14.5° ± 14.2° and Anterior AngleLwas a mean of 4.5° ± 13.6°.
  
  
  CONCLUSIONS
  This study showed that mid-anterior and anterolateral approaches for non-image-guided hip injections or arthrocentesis can avoid the LFCN and be effectively performed in males, despite the exhibited variability in the quantitative descriptions of these techniques. The landmarks and measurements presented can be used as general guidelines for clinical studies regarding hip arthrocentesis and injections.
  
  
  CONCLUSIONS
  The high variability of the needle placement and trajectory of the mid-anterior and anterolateral approaches performed in this study showed that these techniques were not easily quantitatively defined. However, both of these approaches appeared to be safe and effective.
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Mikula
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Schon
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Chase S
authors.initials: CS
authors.lastname: Dean
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Jorge
authors.initials: J
authors.lastname: Chahla
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Renato
authors.initials: R
authors.lastname: Locks
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Alex W
authors.initials: AW
authors.lastname: Brady
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A.. Electronic address: m@mjphilippon.com.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Philippon
mesh_terms: D000328:Adult; D000368:Aged; D000069237:Arthrocentesis / Q000379:methods*; D002102:Cadaver; D004396:Coloring Agents; D006621:Hip Joint / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue