2017 ISAKOS Biennial Congress ePoster #719
Precise Patient Selection For Hip Arthroscopy Using Ultrasound-Guided Hip Injection
Takuma Yamasaki, MD, PhD, Hiroshima JAPAN
Yuji Yasunaga, MD, PhD, Hiroshima JAPAN
Takeshi Shoji, MD, PhD, Hiroshima JAPAN
Nobuo Adachi, MD, PhD, Hiroshima JAPAN
Mitsuo Ochi, MD, PhD, Higashi, Hiroshima JAPAN
Hiroshima university, Hhiroshima, JAPAN
FDA Status Cleared
37 patients with 40 hips who were diagnosed as acetabular labral tear were included in this study. Ultrasound-guided injection could help surgeons to give a more precise diagnosis of the origin of groin pain, which leads to select better operative indication for hip arthroscopy.
Acetabular labral tear (ALT) is considered to be the most frequent pathology as a cause of groin pain. Satisfactory outcomes of hip arthroscopy were reported. However, failure cases of arthroscopic treatment actually exist, and one of the most concerned problem is patient selection for hip arthroscopy. The purpose of this study is to review the patients who underwent conservative treatment including ultrasound-guided hip injection under the diagnosis of ALT, and to assess the efficacy of the technique of hip injection in order to give a more reliable diagnosis and to reach better operative indication for hip arthroscopy.
Materials And Methods
37 patients with 40 hips who were diagnosed as ALT, whose groin pain was evaluated using ultrasound-guided hip injection, were included in this study. Possible ALT was diagnosed with positive impingement test (flexion and internal rotation), and positive findings on the radial view of MRI. The exclusion criteria included radiographic sign of osteoarthritis of the hip; Tönnis grade 2 or higher and acetabular dysplasia (center-edge angle less than 20°), or other previous history of hip joint pathology. The mean age of the patients at the first consultation was 45 years (17-71 years).
Ultrasound-guided intra- and extra-articular injection was performed via anterior approach targeting the layer of fascia between iliopsoas tendon and rectus femoris. Not only anterior inferior iliac spine (AIIS) but also iliopsoas tendon and proximal rectus femoris were visualized in the long axis probing. Clinical evaluation was performed with visual-analogue scale (VAS) score and outcomes of the Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire (JHEQ) at pre-injection and at 4 weeks after injection. Additionally, the period between the initial injection and the last injection, frequency of injection, and location of injection (intra-articular space, iliopsoas tendon, proximal rectus femoris) were investigated.
Medians of the VAS score, the total score of the JHEQ, and the pain subscale score of the JHEQ significantly improved after hip injection, and the movement and mental subscale scores of the JHEQ also improved (Fig.2). Conservative treatment including hip injection was effective in 30 hips (75%). The mean period between the initial injection and the last injection was 5 months (range: 1-24 months), the mean times of injection was 4.5 times, and 10 hips out of 30 hips were performed injection of less than 3 times. In 7 hips, injection to iliopsoas tendon or proximal rectus femoris was more effective than that to intra-articular injection. Ten hips (25%) failed conservative treatment and required arthroscopic treatments. In these patients, the mean 2.4 times of injection were performed before surgery.
Discussion And Conclusion
Considering the source of groin pain, even if intra-articular pathology is detected by radiograph or MRI, extra-articular pathology could not be ruled out. Various causes of groin pain might be hidden behind obvious pathologies such as ALT. Ultrasound-guided injection could help surgeons to give a more precise diagnosis of the origin of groin pain, which leads to select better operative indication for hip arthroscopy.