Hip injection in replaced hip

[pharmer]

What is there to gain by injecting steroid into a hip joint in a patient who has had bilateral hip replacements? I have an orthopedic surgeon referring a patient to me for this. I can understand doing iliopsoas tendon or bursa injection but fail to see the utility in an actual intra-articular steroid injection.


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[BobBarker]

You sure it wasn't a mistake?

 

[cowboydoc]

I think you are spot on. If those don't look promising, a femoral/obturator block and RFA may be worthwhile to consider.

 

[Timeoutofmind]

I think you are spot on. If those don't look promising, a femoral/obturator block and RFA may be worthwhile to consider.

There is an orthopedist I work with who does intra-articular knee injections in people who are status post TKA...
Maybe I am missing something...but makes no sense at all to me

 

[pharmer]

We called his office to clarify. Steroid doesn't fix metal.


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[jonnylingo]

We called his office to clarify. Steroid doesn't fix metal.


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I'd be worried about infection and seeding prosthetic. Has anyone seen a septic prosthesis? I remember hearing this in residency, never seen though.

 

[Taus]

I get referrals for aspirations sp THA but never for ia steroid. I don't think I'd do it if requested.


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[bedrock]

I'd be worried about infection and seeding prosthetic. Has anyone seen a septic prosthesis? I remember hearing this in residency, never seen though.

Agree. Once a surgeon has replaced a joint, he owns it. If he wants a joint injection he can do it himself, I won't do it.

I will evaluate and treat patient for other painful structures like psoas bursitis, and do joint RFA, but no intra-articular injections

 

[knoxdoc]

Do NOT inject into the THA joint. I have seen someone else do this and it became infected. Huge surgical PIA. Even if ortho ordered it, they will point a finger at you. Just say no.

 

[drusso]

Nope. MAYBE an iliopsoas bursa without steroid, but the surgeon has to ask...NICELY!

 

[BobBarker]

Never have done an iliopsoas bursa injection. Looks like just extrarticulaf at 12:00 on the acetab. Is that correct guys? Same location as with the femoral nerve block?

 

[drusso]

Never have done an iliopsoas bursa injection. Looks like just extrarticulaf at 12:00 on the acetab. Is that correct guys? Same location as with the femoral nerve block?

I do it with ultrasound if they're not too fluffy. But, basically, you're right.

 

[Aether2000]

Iliopsoas bursa for anterior pain (US guided of course), gluteal tendon injections if the pain is lateral, and gluteus/piriformis m. if pain is posterior.

 

[bedrock]

Nope. MAYBE an iliopsoas bursa without steroid, but the surgeon has to ask...NICELY!

Agree this is an injection I wouldn't do unless your convinced it will help and you respect the surgeon. That said, I've seen life changing relief on a few patients after THA with these.

 

[clubdeac]

Never have done an iliopsoas bursa injection. Looks like just extrarticulaf at 12:00 on the acetab. Is that correct guys? Same location as with the femoral nerve block?

I think it's a little medial to 1200 on the acetabulum. At least that's where I've done it and I always got a nice linear spread outlining the iliopsoas

 

[Aether2000]

 

[nvrsumr]

 

[Cholula]

Sort of related question. How about a hip with heterotopic ossification but not in a total hip replacement? I have a paraplegic patient with a painful stiff hip, he had gun shot wounds to the hip and spine with a spinal cord injury and heterotopic ossification in the hip. I was thinking to try a steroid IA hip joint injection but I am concerned that could make the HO worse.

 

[clubdeac]

Sort of related question. How about a hip with heterotopic ossification but not in a total hip replacement? I have a paraplegic patient with a painful stiff hip, he had gun shot wounds to the hip and spine with a spinal cord injury and heterotopic ossification in the hip. I was thinking to try a steroid IA hip joint injection but I am concerned that could make the HO worse.

HO is usually outside the joint. Why would a steroid injection into the joint help? Not gonna do anything