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I am a double XL (XXL) sized male with bad arthritis in my hips. The surgeon wants to inject a slippery solution into my worse side to help smooth things out in there. But to be honest, I'm wondering how in the world they can get a needle through all my fat to get to the joint. I was too embarrassed to ask the question when I was in the doctor's office.

Hyaluronic acid injections are used for hip and knee arthritis in an effort to reduce pain, improve motion, and delay surgery. There are several ways to do the injection: the backflow method, fluoroscopy, and arthrography. The backflow method introduces the needle into the joint and a small amount of saline (salt) solution is first injected into the area and then withdrawn to confirm correct needle placement. If the surgeon is unable to aspirate (pull back out) the injected saline, the needle is not in the joint. Fluoroscopy is real-time X-ray. The surgeon can see on a screen exactly where the needle is in relation to the joint as it moves through the skin and down through the soft tissues to the joint. Arthrography (arthrogram) relies on a dye injected into the joint to show that the injected agent actually made it inside the joint. Arthrography requires the use of fluoroscopy to see the contrast medium. A recent (small) study of adults (men and women) with hip osteoarthritis found that for the most accurate placement of the needle, surgeons had to use both fluoroscopy and arthrogram. Obesity wasn't an issue in terms of accuracy in needle position as much as having some outside guidance such as these additional techniques offer. In fact, the majority of patients with hip osteoarthritis are often overweight to obese. Remaining active is an important part of losing weight. And losing weight is an important way to help reduce the stress on your joints. So interventions like hyaluronic acid injections can be very helpful for the overweight patient who wants to avoid joint surgery for as long as possible. Don't be shy about asking your physician for some details on how the procedure is done on someone your size. Patient understanding of and cooperation with surgical procedures is am important part of the treatment.

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