Comparison of the Clinical Efficacy of the Anterolateral and Regular Approaches for Hip Joint Puncture: A Randomized Cross-Over Trial.

Abstract

Objective: Given the limitations of conventional anterior and lateral approaches, such as variable success rates and risks of neurovascular injury, there is a critical need to evaluate alternative techniques that enhance procedural safety and efficiency. This study aimed to investigate the safety and precision of the anterolateral approach for hip joint puncture and compare its clinical efficacy with those of the anterior and lateral approaches.

Methods: A single-center, prospective, randomized Williams crossover trial was conducted from March 2023 to June 2023 involving 30 patients with hip pain. Each patient underwent three hip joint punctures within 3 weeks, all conducted using anatomical landmark-guided blind puncture. The punctures were administered in different sequences of anterior, anterolateral, and lateral approaches, with one-week intervals between punctures. Thirty patients were randomly assigned to six groups (n = 5), following different sequences of the three approaches. The primary outcomes were the success rate and accuracy, and the secondary outcomes were post-puncture pain assessed using the Visual Analogue Scale (VAS), procedure time, puncture depth, and complications.

Results: The anterolateral approach achieved a higher success rate (96.7%) compared to the anterior (86.7%) and lateral (83.3%) approaches; although statistical significance was not reached (p = 0.328). Besides, it significantly shortened procedure duration (72.87 s, SD 9.66) compared to anterior (87.20 s, SD 20.57) and lateral (92.80 s, SD 39.02) approaches (p = 0.006). The puncture path length was shorter with the anterolateral approach (57.77 mm, SD 1.295) than with the lateral approach (63.33 mm, SD 1.295) (p = 0.004). The anterolateral approach achieved lower VAS pain scores (1.77, SD 0.94) compared to the lateral approach (2.90, SD 2.17). During the anterior approach injection, one patient experienced numbness in the lateral thigh of the surgical side.

Conclusion: This preliminary randomized crossover trial demonstrates that the anterolateral approach offers significant advantages in procedural efficiency (reduced time, shorter path length) and suggests a trend toward higher success rates compared to standard anterior and lateral approaches for hip joint puncture. These findings, particularly the improvements in efficiency and patient comfort (lower VAS), support the anterolateral approach as an effective technique.

Level of evidence: I, Randomized controlled trial.

Trial registration: chictr.org.cn: ChiCTR2300074174.