Fewer admissions with Hip POCUS: Part Two

In part two of our discussion regarding hip POCUS-guided arthrocentesis and injections we have just received this case from Dr. Chris Keefer from Brantford General Hospital’s emergency department.

A patient in her late 30s presented with severe hip pain of rapid onset.  No recent trauma.  Recent flu-like illness.  Otherwise healthy with no significant medical conditions.

He used POCUS to scan her affected hip, observed a moderate sized joint effusion, and easily aspirated fluid.  Two things happened as a result.  The patient’s pain was greatly reduced and she could mobilize again.  Analysis of the joint aspirate showed no organisms, crystals or significant cell count and upon review with the orthopaedic surgeon it was felt the patient could be followed closely by him on an outpatient basis since Xray was negative for fracture.  (A CT was eventually done to rule out abscess in the pelvic region too.)

Actually a third result of the aspiration was Dr. Keefer could sleep soundly that night having done the definitive workup and relieving the patient’s pain!

Dr. Keefer, while CEUS IP certified, learned the aspiration technique and hip imaging with POCUS in one brief session.  He felt very comfortable with the procedure and commented that it was less challenging than putting in an IJ line!

Aspirate dynamically using in plane approach.

Aspirate from patient

This is a skill worth learning for the ED physician!  Very satisfying and more effective than just guessing with ESR, CRP, WBC, and crystal balls.

For a nice summary of the workup of mono arthritis you can look here:

CMAJ. 2009 Jan 6; 180(1): 59–65