Interventional MSK procedures: the hip

Abstract

Percutaneous musculoskeletal procedures are widely accepted as low invasive, highly effective, efficient and safe methods in a vast amount of hip pathologies either in diagnostic or in therapeutic management. Hip intra-articular injections are used for the symptomatic treatment of osteoarthritis. Peritendinous or intrabursal corticosteroid injections can be used for the symptomatic treatment of greater trochanteric pain syndrome and anterior iliopsoas impingement. In past decades, the role of interventional radiology has rapidly increased in metastatic disease, thanks to the development of many ablative techniques. Image-guided percutaneous ablation of skeletal metastases provides a minimally invasive treatment option that appears to be a safe and effective palliative treatment for localized painful lytic lesion. Methods of tumour destruction based on temperature, such as radiofrequency ablation (RFA) and cryotherapy, are performed for the management of musculoskeletal metastases. MR-guided focused ultrasound surgery provides a non-invasive alternative to these ablative methods. Cementoplasty is now widely used for pain management and consolidation of acetabular metastases and can be combined with RFA. RFA is also used to treat benign tumours, namely osteoid osteomas. New interventional procedures such as percutaneous screw fixation are also proposed to treat non-displaced or minimally displaced acetabular roof fractures. INTRODUCTIONHip intra-articular injections have been used for many years as a diagnostic and/or therapeutic tool and even today remain an effective treatment for osteoarthritis providing pain relief. Ultrasound guidance can be used for injections in patients with greater trochanteric pain syndrome and CT scan guidance for corticosteroid injection in the management of anterior iliopsoas impingement after total hip arthroplasty. Interventional radiology plays a major role in the management of bone tumours. Several image-guided percutaneous ablation methods have proved effective for palliation of metastases involving bone and for the treatment of benign bone tumours, namely osteoid osteoma. To treat pain and consolidate the bone, cementoplasty could be required. In the therapeutic management of acetabular fractures, the combination of CT and fluoroscopy guidance could have a place in treating non-displaced or minimally displaced acetabular roof fractures.

Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

“…Intra-articular injections or aspiration are widely used for both diagnostic and therapeutic hip purposes. 5,6 The presence of a joint effusion is confirmed by an increased volume of fluid detected in the anterior recess of the hip joint. US is able to detect even small amounts of fluid by positioning the probe in the oblique sagittal plane along the line of the femoral neck.…”

Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin

“…Ultrasound has an important role in dynamic assessment of the iliopsoas tendon and guiding a safe method of delivering therapeutic or diagnostic injections. The only potential immediate complication is transient femoral nerve palsy [29]. Complete or near complete relief of the symptoms confirms the diagnosis of iliopsoas impingement.…”

Management of Pathologic Fractures Around the Hip: Part 1–Femur

“…These procedures can be performed using radiofrequency ablation (RFA), cryotherapy, or MR-guided focused ultrasound surgery. 28 However, as these techniques are generally not indicated for the proximal femur, we will not comment on them extensively here.…”