My favorite orthopedic surgeon retired last year. He kept me on my feet and out of the operating room with this old, arthritic hip of mine. Always did my injections in his office. Now the new replacement doc insists on a much more expensive way to do the same thing with imaging and hospital visit required. Is all this hoopla really necessary for a simple injection? Good grief!
With the new focus on evidence to support the use of procedures like blind injections (given by visual guidance only), there's plenty of proof now that you only have a 50-50 chance of getting the agent into the joint. And that's true even for very experienced physicians who give 100s of injections.
With the availability of advanced imaging techniques like real-time X-rays and ultrasound, researchers have been able to study the accuracy and reliability of different techniques for intraarticular (into the joint cavity) injections.
And now they know that even some imaging-guided injections don't truly hit the mark. It can look like the needle is in the correct position even with fluoroscopy. But follow-up arthrography shows it's not in the joint after all. Arthrography requires injecting a special substance or contrast dye into the joint space. It allows the physician to see soft tissues and joint structures as well as needle placement and delivery of the injected material.
A physician who is concerned about accuracy and positive results will use both imaging and arthrography when performing hip injections. It sounds like you are in good hands with the new surgeon. Give it a try at least once and see what you think!
Demirhan Duracoglu, MD, et al. Evaluation of Needle Positioning During Blind Intra-Articular Hip Injections for Osteoarthritis: Fluoroscopy Versus Arthrography. In Archives of Physical Medicine and Rehabilitation. December 2009. Vol. 90. No. 12. Pp. 2112-2115.
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