Hip Therapeutic Injection

Standard pre-procedure workup: consent, indications, contraindications, allergies, diabetes history, and baseline pain level.

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

Place the curved probe longitudinally over the anterior hip to display the femoral head–neck junction. Identify the anterior joint capsule and the overlying iliopsoas tendon. Use color Doppler to locate the femoral neurovascular bundle (medial); confirm the needle path avoids these structures.

Click for annotated view

Mark the needle entry site and probe position on the skin.

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

Place sterile drape and sterile probe cover.

Draw up medications as listed.

Under ultrasound guidance, inject 1% lidocaine superficially using the 25g 1.5″ needle. Anesthetize the subcutaneous tissues and the anterior joint capsule.

Exchange 25g needle for the 22g 3.5″ spinal needle. Advance under real-time ultrasound guidance toward the anterior hip joint at the femoral head–neck junction.

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

Once intra-articular position is confirmed, exchange the syringe for the steroid/ropivacaine mixture. Inject 3–5 cc slowly. Confirm continued easy flow throughout injection.

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

Reassess pain level and provide patient with a pain log.