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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Aspiration of the Hip Joint

- Discussion:
    - anterior approach:
          - femoral artery may be palpated in femoral triangle, & may be used as a guide in aspirating the hip joint;
          - palpate the femoral pulse just as it exits the inguinal ligament;
          - entry point is one inch lateral to the artery (at the inguinal ligament) and one inch below the inguinal ligament;
                 - going lateral 1 inch will also make entry site approx 1 in below ligament;
                 - needle entry is then straight down into the lateral half of the joint cavity;
          - disadvantages: if the surgeon is not in the capsule when the contrast dye is injected, then contrast material will
                 collect and will obstruct needle visualization;
    - lateral approach:
          - greater troch is palpated & needle inserted just anterior to its superior tip;
          - needle is directed 45 deg cephalad, & parallel to table (pt is supine);
          - femoral neck will usually be met & needle can then be directed sl cephalad and proximal to enter the hip joint;
          - greater trochanter is palpated, & needle is inserted from side, in front of its upper margin and approx parallel to femoral neck, so that needle
                    enters capsule obliquely after passing thru atachments of gluteus medius & minimus;
          - disadvantages: in patients with large thighs, the needle may not be long enough to reach the joint;
    - medial approach:
          - needle is inserted just posterior to the insertion of the adductor longus muscle, and anterior to the gracilis;
          - flouroscopy is then used to direct the needle into the hip joint



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 5, 2013 1:20 pm