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Hip/Knee Injection

Hip/Knee Injection. Mr Andrew Armitage Horder 2013. Hip injections. Trochanteric Bursitis Meralgia paraesthetica Intraarticular - Diagnostic Target injections - iliopsoas. Trochanteric Bursitis. Trochanteric Bursa. Incidence. 1.8 per 1000 per year 4 th to 6 th decade Women

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Hip/Knee Injection

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  1. Hip/Knee Injection Mr Andrew Armitage Horder 2013

  2. Hip injections • Trochanteric Bursitis • Meralgiaparaesthetica • Intraarticular - Diagnostic • Target injections - iliopsoas

  3. Trochanteric Bursitis

  4. Trochanteric Bursa

  5. Incidence • 1.8 per 1000 per year • 4th to 6th decade • Women • Obesity • Low Back pain • Osteoarthitis

  6. Causes • Very often no clear cause • Trauma • Microtrauma (overuse) • Osteoarthritis • Post THR • Leg length inequality

  7. Presentation • Patient usually complains of hip pain • Pain over lateral side of hip (over trochanter) • Pain when lying on side • Worse with flexn/extn, increased activity • Not usually in groin • Can radiate down lateral thigh • Post surgery

  8. Differential Diagnosis • Trochanteric bursitis • Snapping Iliotibial band • Back pain / radiation • Hip arthritis • MeralgiaParaesthetica • Gluteus medius inflammation

  9. Investigation • Rareley required initially • Pathognomic-pain over trochanter • Ultrasound • Hip Xray • MRI

  10. Treatment • Conservative • NSAID • Analgesia • Reduced activity • Topical anti-inflammatories • Physiotherapy • Massage • Ultrasound • ESWT • Shockwave therapy

  11. Treatment • Injection • Local anaesthetic – 10ml 0.5% Marcaine • Steroid - 80 mg depo-medrone • Big needle • Relaxed Patient • Target point • Hit bone

  12. Treatment - outcomes • Conservative • Majority settle • Injection • 60 – 90 % success • Can take 4 wks • Can be repeated • Surgery • Very rarely indicated

  13. Meralgiaparaesthtica • Lateral cutaneous nerve of thigh • Tinnels • Neuralgic pain

  14. Knee injections • Intraarticular • Osteoarthritis • Inflammatory disease • Chondromalacia patellae – be carefull • Extraarticular • Pre-patella neuroma • Pes anserine bursitis • Iliotibial band syndrome • Patella tendonitis • Prepatella bursitis

  15. Intraarticular injections • Steroids • 10ml 0.5% marcaine • 80mg Depomedrone • Viscosupplementation • Synvisc 1 • Durolane

  16. Steroids • Help 50 % with arthritic change • Can take 4-6 wks to have effect • 5-10 % worse short period of time • Tiny risk of infection • Very variable benefit duration • Not if imminent TKR - ^ risk of infection • More benefit with effusion • Very unfit

  17. Viscosupplementation • Variable outcome • Grade 1-2 oa changes • Help 50 -60 % • Can last up to a year • Can be painful • £2-300

  18. Under Patella

  19. Under patella

  20. Arthroscopy portal

  21. Pes anserine bursitisiliotibial band syndrome • Analgesia • Rest • Physio • Targeted injection

  22. Pre-patella neuroma • In bursa • Very sensitive • Can feel tissue lump/band • 2ml local and steroid • ? Immediate effect

  23. Pre-Patella bursitis • Inflammatory • Infective • NSAID/rest/ ? Abs • Generally don’t inject • Occaisionally surgery

  24. Patella Tendonitis • Rest • Analgesia • Physiotherapy / U/S • Shockwave therapy • Do Not Inject

  25. Questions ?

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