J Korean Soc Radiol.  2013 Mar;68(3):237-243. 10.3348/jksr.2013.68.3.237.

The Effectiveness of Ultrasound-Guided Steroid Injection for Femoroacetabular Impingement: A Comparison between the Extra-Articular and Intra-Articular Approaches

• Jeon CH
• Kim S
• Lee JW
• Lee YK
• Koo KH
• Kang HS

• KMID: 1748458
• DOI: http://doi.org/10.3348/jksr.2013.68.3.237

Abstract

PURPOSE
To assess the effectiveness of pain control using ultrasound-guided steroid injection by the extra-articular and intra-articular approaches to femoroacetabular impingement patients.
MATERIALS AND METHODS
From September through December 2010, 18 patients with clinical suspicion of femoroacetabular impingement syndrome underwent ultrasound-guided steroid and local anesthetics injection: a total of 20 cases, including 16 cases of ipsilateral and 2 cases of bilateral injection. Extra-articular or intra-articular approach was selected for each patient, randomly and alternately. Nine cases were performed by extra-articular approach and 11 cases were performed by intra-articular approach. Every patient was observed in the outpatient clinic and visual analogue scale (VAS) was taken and compared before and after the procedure in all patients.
RESULTS
Pre-injection average VAS value of extra-articular approached cases was 5.22 +/- 1.99 and post-injection average VAS value was 4.11 +/- 1.96, which is statistically insignificant (p < 0.156). The average VAS value of intra-articular approached cases was decreased from 5.72 +/- 2.15 to 2.91 +/- 2.30 after injection, which is statistically significant (p < 0.006).
CONCLUSION
Ultrasound guided intra-articular approached steroid and local anesthetics injection could be effective in controlling pain for patients with femoroacetabular impingement syndrome.

MeSH Terms

Ambulatory Care Facilities
Anesthetics, Local
Femoracetabular Impingement
Humans
Anesthetics, Local

Figure

• 

  Fig. 1 Example of ultrasound-guided intra-articular steroid injection in a 40-year-old male patient. A. On ultrasound image before contrast injection, tip of 22-gauge 3.5-inch spinal needle is placed in the hip joint cavity (arrowhead). B. Intra-articular injection is performed. A hyperechoic line shows injectates (arrows). C. A fluoroscopic image is checked and this image shows intra-articular contrast filling of the hip joint.

• 

  Fig. 2 Example of ultrasound-guided extra-articular steroid injection in a 51-year-old female patient. A. On ultrasound image of extra-articular injection, tip of 22-gauge 3.5-inch spinal needle is placed at the undersurface of proximal rectus femoris muscle (arrowhead). A hyperechoic line shows injectates (arrows). B. A fluoroscopic image is checked and this image shows extra-articular contrast filling of the hip joint.

Reference

1. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know. AJR Am J Roentgenol. 2007. 188:1540–1552.

2. Beall DP, Sweet CF, Martin HD, Lastine CL, Grayson DE, Ly JQ, et al. Imaging findings of femoroacetabular impingement syndrome. Skeletal Radiol. 2005. 34:691–701.

3. Hwang DS, Nam DC, Yang JH, Kang TH. Usefulness of hip joint AP plain X-ray radiographs in femoroacetabular impingement. J Korean Hip Soc. 2007. 19:105–111.

4. Şahin N, Atici T, Öztürk A, Özkaya G, Özkan Y, Avcu B. Prevalence of femoroacetabular impingement in asymptomatic contralateral hips in patients with unilateral idiopathic osteoarthritis. J Int Med Res. 2011. 39:790–797.

5. Palmer WE. Femoroacetabular impingement: caution is warranted in making imaging-based assumptions and diagnoses. Radiology. 2010. 257:4–7.

6. Clohisy JC, McClure JT. Treatment of anterior femoroacetabular impingement with combined hip arthroscopy and limited anterior decompression. Iowa Orthop J. 2005. 25:164–171.

7. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004. 61–66.

8. Crawford JR, Villar RN. Current concepts in the management of femoroacetabular impingement. J Bone Joint Surg Br. 2005. 87:1459–1462.

9. Wisniewski SJ, Grogg B. Femoroacetabular impingement: an overlooked cause of hip pain. Am J Phys Med Rehabil. 2006. 85:546–549.

10. Hart ES, Metkar US, Rebello GN, Grottkau BE. Femoroacetabular impingement in adolescents and young adults. Orthop Nurs. 2009. 28:117–124. quiz 125-126.

11. Emara K, Samir W, Motasem el H, Ghafar KA. Conservative treatment for mild femoroacetabular impingement. J Orthop Surg (Hong Kong). 2011. 19:41–45.

12. Ravaud P, Moulinier L, Giraudeau B, Ayral X, Guerin C, Noel E, et al. Effects of joint lavage and steroid injection in patients with osteoarthritis of the knee: results of a multicenter, randomized, controlled trial. Arthritis Rheum. 1999. 42:475–482.

13. Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions--systematic review. Br J Sports Med. 2011. 45:49–56.

14. Kivlan BR, Martin RL, Sekiya JK. Response to diagnostic injection in patients with femoroacetabular impingement, labral tears, chondral lesions, and extra-articular pathology. Arthroscopy. 2011. 27:619–627.

15. Panzer S, Augat P, Esch U. CT assessment of herniation pits: prevalence, characteristics, and potential association with morphological predictors of femoroacetabular impingement. Eur Radiol. 2008. 18:1869–1875.

16. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005. 87:1012–1018.

17. Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006. 240:778–785.

18. Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. 2005. 236:588–592.

19. Anderson SE, Siebenrock KA, Tannast M. Femoroacetabular impingement: evidence of an established hip abnormality. Radiology. 2010. 257:8–13.

20. Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debride ment of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004. 178–181.

21. Chang JS, Son HC, Park JH, Kim KH. Periacetabular osteotomy for acetabular retroversion: a case report. J Korean Hip Soc. 2003. 15:158–161.

22. Hwang DS, Lee CH, Lee CH. Arthroscopic treatment of osseous abnormalities as a cause of femoroacetabular impingement: preliminary clinical results. J Korean Orthop Assoc. 2006. 41:778–784.

23. Sung YB. Osteotomy around the hip: overview. J Korean Hip Soc. 2007. 19:236–239.

24. Hwang DS, Nam DC, Yang JH. Arthroscopic treatment of osseous abnormalities as a cause of femoroacetabular impingement: preliminary clinical results. J Korean Hip Soc. 2007. 19:112–120.

25. Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009. 467:739–746.

26. Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007. 35:1571–1580.

27. Ayeni OR, Wong I, Chien T, Musahl V, Kelly BT, Bhandari M. Surgical indications for arthroscopic management of femoroacetabular impingement. Arthroscopy. 2012. 28:1170–1179.

28. Rebello G, Spencer S, Millis MB, Kim YJ. Surgical dislocation in the management of pediatric and adolescent hip deformity. Clin Orthop Relat Res. 2009. 467:724–731.

29. Bardakos NV, Villar RN. Predictors of progression of osteoarthritis in femoroacetabular impingement: a radiological study with a minimum of ten years follow-up. J Bone Joint Surg Br. 2009. 91:162–169.

30. Hartofilakidis G, Bardakos NV, Babis GC, Georgiades G. An examination of the association between different morphotypes of femoroacetabular impingement in asymptomatic subjects and the development of osteoarthritis of the hip. J Bone Joint Surg Br. 2011. 93:580–586.

31. Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006. 88:925–935.