Here's how we do a hip arthrogram:

1. Position the patient supine on the fluoroscopy table. Then palpate and mark the femoral artery. Avoid this area!
2. Position the hip in slight internal rotation, then localize the femoral head-neck junction.
3. There are possible ways to tap a hip. Our fellows currently prefer to place their needles at the superior aspect of the femoral head-neck junction.
4. Prepare the overlying skin with antiseptic solution and place sterile drapes over the area.
5. Prepare the buffered lidocaine anesthetic solution.
6. Prepare the MR arthrography contrast solution.
7. Anesthetize the planned needle tract with buffered lidocaine solution.
8. Advance a 20 - 22 gauge spinal needle directly into the joint, keeping the needle perpendicular to the table until the needle tip contacts the femoral head.
9. Remove the stylet from the needle.
10. Fluoroscopic spot image shows the needle hub superimposed over the needle tip.
11. If there is a suspected joint effusion, consider syringe aspiration of fluid to avoid overdilution of contrast.
12. After dripping contrast into the needle hub to eliminate air, attach the contrast-filled tubing/syringe.
13. Inject a small mount of contrast to confirm intra-articular position. Contrast should flow freely away from the needle tip, opacifying the joint capsule.
14. Document the intra-articular position of your needle and injection with fluoroscopic spot views.