Hip Joint Injection: Anatomic Foundations, Procedural Technique, and Management of Osteoarthritic Hip Pain

Hip pain ranks among the most frequent and functionally disabling musculoskeletal complaints encountered in outpatient clinical practice, particularly affecting aging populations. This article provides a comprehensive, clinically oriented overview of fluoroscopically guided intra-articular hip injection, addressing the relevant anatomy of the femoroacetabular joint, the pathophysiological progression of hip osteoarthritis, and the evidence-based indications for injection therapy. The discussion emphasizes the three foundational pillars of procedural success: minimizing patient discomfort, maintaining rigorous safety standards, and executing precise needle technique to achieve reliable intra-articular access. Absolute contraindications—including septic arthritis, overlying cellulitis, bacteremia, acute fracture, and anaphylaxis to injectable agents—are delineated, and a stepwise approach to patient preparation, fluoroscopic positioning, contrast arthrography, and therapeutic delivery is provided. Clinical significance is considered within the broader context of multimodal management, where intra-articular corticosteroids, hyaluronic acid, and platelet-rich plasma serve as adjuncts to nonpharmacological interventions such as physical therapy, weight reduction, and assistive devices. Complications are rare but recognized, including post-injection flare, allergic reactions, and small vessel injury. Ultimately, effective healthcare team outcomes depend upon seamless collaboration between the proceduralist and the radiology technologist, with meticulous documentation of pain relief to guide referring providers and optimize longitudinal care.