Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography

Arch Phys Med Rehabil. 2009 Dec;90(12):2112-5. doi: 10.1016/j.apmr.2009.08.137.


Diraçoğlu D, Alptekin K, Dikici F, Balci HI, Ozçakar L, Aksoy C. Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography.

Objective: To evaluate needle positioning during blind/anatomically referenced hip joint injections for osteoarthritis (OA).

Design: Experimental clinical study.

Setting: Operating theater of a university hospital.

Participants: Patients (N=16) (10 women, 6 men), who were diagnosed as having OA according to the American College of Rheumatology criteria and whose radiologic grades were II or III according to Kellgren-Lawrence.

Interventions: Three bilateral and 13 unilateral hip injections were performed (3 times at 1-week intervals). After it was presumed blindly that the needle was within the joint, the location of the needle was checked with backflow technique and fluoroscopy. Entrance to the joint cavity was also ensured by reconfirmation with contrast medium, and the procedure was then terminated with hyaluronic acid injection.

Main outcome measures: Assessment of blind needle placement into the hip joint by using backflow technique, fluoroscopic images, and contrast enhancement.

Results: The location of the needle was fluoroscopically confirmed to be at the proper position in 38 (66.7%) of the 57 blind interventions. Furthermore, in 29 (76.3%) of those 38 interventions, localization of the intra-articular needle could be confirmed by intra-articular contrast uptake. Overall, 29 of 57 (50.9%) blind interventions exhibited intra-articular contrast enhancement. Backflow was not observed in 23 (79.3%) of these 29 interventions. Five (17.9%) of 28 interventions with no contrast uptake showed backflow.

Conclusions: In light of our results, we suggest that blind injection of the osteoarthritic hip joint can be inaccurate even with careful technique. Further, the backflow method does not appear to be reliable, and guidance during the injection seems to be necessary.

MeSH terms

  • Arthrography*
  • Contrast Media
  • Female
  • Fluoroscopy*
  • Hip Joint / diagnostic imaging*
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Injections, Intra-Articular / methods*
  • Iohexol
  • Male
  • Middle Aged
  • Needles
  • Osteoarthritis, Hip / drug therapy*
  • Viscosupplements / administration & dosage


  • Contrast Media
  • Viscosupplements
  • Iohexol
  • Hyaluronic Acid