2
Infiltration Technique Descriptions
THA Posterior Approach
Injection solution includes bupivacaine liposomal injectable suspension (EXPAREL)
20 mL and 0.25% bupivacaine with epinephrine 30 mL. Normal saline 10-20 mL may
be added if extra volume is needed.
Infiltration Technique
Local
Analgesic
Volume
Step 1: Deep Injection
Aer the joint is prepared for implantation, inject 20 mL into the anterior
capsule and periosteum, the inferior capsule, the superior capsule and
periosteum, the psoas tendon sheath, the superior deep layer of abductors,
and the anterior femoral periosteum.
20 mL
Note: Observe caution regarding the posterior injection due to the proximity of
the sciatic nerve.
Step 2: Posterior Injection
Inject 10 mL into the short external rotators and posterior capsule
(aer repair), the abductors, the anterior femoral so tissues, the
periosteum of the trochanter and the vastus lateralis.
10 mL
Note: Observe caution regarding the posterior injection due to the proximity of
the sciatic nerve.
Step 3: Superficial Injection
Aer insertion of the femoral prosthesis, inject the remaining 20 mL
into the tensor layer, ilio-tibial band, gluteus maximus, subcutaneous
layer and skin.
20 mL
Note: For revisions:
• Extend the deep injections, prior to stem placement but following placement
of the acetabular cup:
▶ more broadly superiorly in the region of the peri-acetabular
periosteum
▶ further along the femoral periosteum
▶ into the vastus lateralis & deep quadriceps muscles
• Extend the mid-layer injections, being careful to avoid the sciatic nerve:
▶ into the gluteus maximus
▶ into the interosseus membrane
• Extend the superficial injections:
▶ more broadly along the deep tissues & subcutaneous layers
