Hip Arthrogram Injection

Standard pre-procedure workup: consent, indications, contraindications, allergies. Confirm gadolinium is appropriate (check renal function if intravenous gadolinium history is a concern — intra-articular dose is very small).

Position patient supine with the leg in slight external rotation. A pillow under the knee helps maintain a neutral, comfortable position.

Place the curved (6–8 MHz) probe longitudinally over the anterior hip, angled to display the femoral head–neck junction. This is the target for injection. Identify the anterior joint capsule, overlying iliopsoas tendon, and femoral vessels (medial — keep track of these to avoid).

Click for annotated view

Mark the needle entry site and probe position on the skin. Use color Doppler to confirm the femoral vessels are not in the needle path.

Prep with betadine or chlorhexidine × 3 over a wide area.

Place sterile drape and sterile probe cover.

Draw up medications. Prepare the gadolinium/saline mixture (10 cc NS + 0.1 cc Gd). Label all syringes clearly.

Under ultrasound guidance, inject 1% lidocaine superficially using the 25g 1.5″ needle. Anesthetize down to the joint capsule level.

Exchange 25g needle for the 22g 3.5″ spinal needle. Advance under real-time ultrasound guidance toward the femoral head–neck junction, targeting the anterior joint recess just inferior to the anterior labrum.

Once the needle tip contacts the femoral neck cortex, test-inject with 1–2 cc of 1% lidocaine. Confirm easy flow and joint distention. If resistance is felt, slightly retract or redirect the needle.

Once intra-articular position is confirmed, exchange the lidocaine syringe for the gadolinium/saline mixture. Inject the full 10 cc into the joint, confirming continuous easy flow.

Document joint distension and confirm no extravasation of injectate.

Remove needle, clean the skin, and place a bandage over the entry site.

Send patient immediately for MRI. Avoid unnecessary movement or exercise beforehand to minimize gadolinium dilution.