Hip/Knee Injection
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Transcript of Hip/Knee Injection
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Hip/Knee InjectionMr Andrew Armitage
Horder 2013
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Hip injections• Trochanteric Bursitis• Meralgia paraesthetica• Intraarticular - Diagnostic• Target injections - iliopsoas
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Trochanteric Bursitis
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Trochanteric Bursa
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Incidence• 1.8 per 1000 per year• 4th to 6th decade• Women• Obesity• Low Back pain• Osteoarthitis
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Causes• Very often no clear cause• Trauma• Microtrauma (overuse)• Osteoarthritis• Post THR• Leg length inequality
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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
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Differential Diagnosis• Trochanteric bursitis• Snapping Iliotibial band• Back pain / radiation• Hip arthritis• Meralgia Paraesthetica• Gluteus medius inflammation
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Investigation• Rareley required initially– Pathognomic-pain over trochanter
– Ultrasound– Hip Xray–MRI
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Treatment• Conservative
– NSAID – Analgesia– Reduced activity– Topical anti-inflammatories
• Physiotherapy– Massage– Ultrasound
• ESWT– Shockwave therapy
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Treatment• Injection– Local anaesthetic – 10ml 0.5% Marcaine– Steroid - 80 mg depo-medrone– Big needle– Relaxed Patient– Target point– Hit bone
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Treatment - outcomes • Conservative
– Majority settle
• Injection– 60 – 90 % success– Can take 4 wks– Can be repeated
• Surgery– Very rarely indicated
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Meralgia paraesthtica
• Lateral cutaneous nerve of thigh
• Tinnels • Neuralgic pain
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Knee injections• Intraarticular
– Osteoarthritis– Inflammatory disease– Chondromalacia patellae – be carefull
• Extraarticular– Pre-patella neuroma– Pes anserine bursitis– Iliotibial band syndrome– Patella tendonitis– Prepatella bursitis
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Intraarticular injections• Steroids – 10ml 0.5% marcaine– 80mg Depomedrone
• Viscosupplementation– Synvisc 1– Durolane
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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
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Viscosupplementation• Variable outcome• Grade 1-2 oa changes• Help 50 -60 %• Can last up to a year• Can be painful• £2-300
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Under Patella
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Under patella
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Arthroscopy portal
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Pes anserine bursitisiliotibial band syndrome
• Analgesia• Rest• Physio• Targeted injection
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Pre-patella neuroma
• In bursa• Very sensitive • Can feel tissue lump/band• 2ml local and steroid• ? Immediate effect
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Pre-Patella bursitis
• Inflammatory• Infective• NSAID/rest/ ? Abs• Generally don’t inject• Occaisionally surgery
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Patella Tendonitis
• Rest• Analgesia• Physiotherapy / U/S• Shockwave therapy• Do Not Inject
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Questions ?