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Am Fam Physician. 2024;109(1):61-70

This is one of a series of articles produced in collaboration with the American Medical Society for Sports Medicine.

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Hip and knee injections are useful diagnostic and therapeutic tools for family physicians. This article reviews anatomic landmark–guided and ultrasound-guided injections and aspiration techniques for greater trochanteric pain syndrome, the hip joint, the knee joint, the pes anserine bursa, and the iliotibial band. Indications for injections include acute and chronic inflammatory conditions, such as rheumatoid arthritis; osteoarthritis; overuse; and traumas. Joint aspirations may be performed to aid in the diagnosis of unexplained effusions and to relieve pain. Technique, injectant, and follow-up timing depend on the physician's comfort, experience, and preference. Infections of the skin or soft tissue are the primary contraindications to injections. The most common complications are local inflammatory reactions to the injectant. These reactions usually cause soreness for 24 to 48 hours, then spontaneously resolve. Follow-up after injections is usually scheduled within two to six weeks.

Family physicians often use joint injections for the diagnosis and treatment of common musculoskeletal conditions. This review discusses techniques using anatomic landmark–guided and ultrasound-guided injections and aspiration for the hip and knee; however, many other techniques are also available for injections. Family physicians are becoming more comfortable with the use of point-of-care ultrasonography (POCUS) for diagnosis and guided procedures; however, the terminology and techniques of POCUS are beyond the scope of this article. Intra-articular injections guided by POCUS are more accurate than anatomic landmark–guided injections of the hip and knee.110

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