Injections in and around a person’s hip joint may help a person avoid surgery and improve his or her activity immensely. There are several different reasons an injection in or around a person’s hip may be necessary.
Why are hip joint injections performed?
The first reason to do a hip injection is for diagnostic purposes. It may not be absolutely clear that a person’s hip pain is being generated from a problem inside the hip joint itself. Most commonly, hip pain is coming from an arthritis situation inside the joint (osteoarthritis), but this is not always the case.
For instance, an individual may have a problem in the lumbar spine that is causing referred pain into the hip area (e.g. spinal stenosis). It may be necessary to do a diagnostic hip joint injection to see if in fact the pain is relieved for confirmation of the joint itself being the problem.
The second reason to perform a hip joint injection is for therapeutic purposes. Once the hip itself is deemed to be the source of an individual’s hip pain, an injection into the joint can provide significant pain relief. Most commonly this is performed with cortisone medication.
In what situations is a hip injection helpful?
The most common reason to perform a hip joint injection is for arthritis in the joint. Usually this is the “wear and tear” type of arthritis known as osteoarthritis. Pain relief from a hip joint steroid injection may last anywhere from a few days to about six months.
It is often times an extremely effective method of pain relief which can avoid the need for a hip replacement surgery or delay the operation. Another injection that is performed around the hip is on the outside area over the greater trochanteric bursa. This is an injection performed in the office in the soft tissues that are inflamed. The diagnosis is called greater trochanteric bursitis and it is extremely common as a person ages, or happens a lot after your surgery.
How is a hip joint injection performed?
Injections that put medication into the joint itself should always be done under fluoroscopy. This is a real-time form of x-ray and helps to ensure accuracy for needle placement. The concern with the hip joint is that there is a lot of soft tissue between the skin and the joint itself. In the soft tissue there are some very important vascular structures and nerves, so performing this injection blindly without fluoroscopy is not a great idea.
Hip joint injections are typically performed as an outpatient at a procedure center. The patient may or may not need IV sedation, often times simply numbing the skin and soft tissues are enough for the procedure.
Because of the considerable depth of soft tissue between the skin and the joint, a longer needle may be necessary so sedation may be requested by the patient due to anxiety. Once the joint is reached, the Arizona pain management doctor will typically insert some dye to make sure they are actually inside the joint.
Once this is confirmed, the physician will inject steroid medication along with some numbing medicine to provide instant pain relief. Once the numbing medicine wears off within 24 hours, steroid medicine will hopefully “kick in” and work for months.
What types of medicine are used for hip joint injections?
By and large, the best pain relief is with steroid medication. There are different formulations of steroid including Kenalog, Depo-Medrol and others. There are also some nonsteroidal medications coming into vogue that can be beneficial as well.
As with the knee joint, the hip can receive some benefits from hyaluronic acid injections, which is a vital component to the joint fluid and significant pain reduction can be achieved with injecting this material. These injections often require a series of 3 to 5 injections every other week.
Within the near future, the hope is that regenerative medicine with stem cell injections will show efficacy and begin to be utilized for arthritic conditions within the hip joint.
If an injection is being performed into the hip for diagnostic purposes, the procedure is performed the same way. However, a physician may only inject numbing medicine initially to see what kind of pain relief is achieved. If immediate pain relief is achieved, then the answer is that the hip is causing the patients discomfort.
If immediate pain relief is not achieved, then the second option is that the pain is coming from somewhere else and being referred to the hip. One common reason for this is spinal stenosis causing pain in the buttocks that wraps around to the hip area. If this is the case, the patient would benefit more from injections into the epidural space of the lumbar spine rather than the hip joint.
How well do hip joint injections work?
These injections work exceptionally well. There’ve been a few studies looking at the effect of steroid injections into the hip. One that was performed in 2007 was published in the Journal of Arthritis and Rheumatology showed that over two thirds of those receiving steroid injections received at least a 50% reduction in their hip pain for three months. Then the pain reduction began to wear off, so repeat injections every few months may be necessary.
There was also a study performed in 2009 in the same journal looking at the effects of hyaluronic acid being injected into symptomatic hip joints. This study showed that one injection was ineffective for pain management. As a result of those findings it may be necessary for a series of injections to receive adequate pain relief with hyaluronic acid. These injections are also known as Synvisc, Hyalgan, Orthovisc, Supartz and other brand names.
If an individual has a diagnostic hip injection with inadequate pain relief, further workup should be performed to see where the pain is coming from, such as the lumbar spine. Epidural injections work very well for spinal stenosis and may be the next step.
What are the risks of hip injections?
Risks are low for a hip joint injection, especially if it is performed under image guidance using fluoroscopy or ultrasound for accuracy and safety. There is a risk of infection, bleeding, nerve injury and a small risk of side effects with steroids.
These may include slight blood sugar elevation, temporary difficulty with sleeping, water retention that is also temporary, and a few other issues. Typically these are only temporary.
The main risk with a hip joint injection is that it may not work adequately for pain relief. Along with physical therapy, pain medication, Phoenix chiropractor treatment and other modalities such as TENS units, often times an individual may be able to avoid surgery and achieve over 90% pain relief for extended periods of time.
Arizona Pain Specialists has an award-winning team of Board Certified pain management doctors and chiropractors at Valleywide locations serving Phoenix, Scottsdale, Glendale, Chandler, Mesa, surprise, Tempe and more.
Call today at 602-507-6550 to receive expert treatment for your hip pain.