Hip Joint Injections for Pain Relief

Hip injections are done with the goals of:

• Providing pain relief by injecting medication directly into the hip joint to reduce inflammation
• Confirming a diagnosis (if there is even temporary improvement)

If your hip joint is affected by arthritis, a labral tear or other injury, or if you experience hip pain along with lower back pain, a hip joint injection may be recommended.

Purpose of Injections for Hip Pain

Hip injections involve injecting medicine directly into the hip joint – the large joint where the upper leg joins the pelvis.

These injections help diagnose the source of pain, as well as provide pain relief.

• Diagnostic function: By placing numbing medicine into the joint, the amount of immediate pain relief experienced will help confirm or deny the joint as a source of pain. If complete pain relief is achieved while the hip joint is numb it means this hip joint is likely to be the source of pain.
• Pain relief function: Along with the numbing medication, cortisone is also injected into the hip joint to reduce inflammation, which can often provide long term pain relief.

Following the injection, it is important to keep track of your pain if there is a diagnostic reason for the injection.  Patients are often referred for physical therapy as an adjunctive treatment.

Hip Joint Injection Procedure: Step by Step

Fluoroscopy (live X-ray) is commonly used in hip joint injections for guidance in properly targeting and placing the needle, and for avoiding nerve or other injury. Alternatively, ultrasound can be used by a trained practitioner.

On the day of the injection, patients are often advised to avoid driving and doing any strenuous activities (though make sure to follow your doctor’s recommendations).

The hip joint injection procedure includes the following steps:

1. You lie face up on an X-ray table and the skin over the groin and anterior hip is sterilized. The hip injection site is on the front of the hip.
2. The physician may numb a small area of skin with an anesthetic (a numbing medicine). The patient may feel a sting that will last for a few seconds.
3. The physician uses X-ray guidance (fluoroscopy) or ultrasound guidance to direct a needle into the hip joint.
4. Contrast is often injected to confirm that the medicine reaches the joint and doesn’t go anywhere else.
5. A small mixture of anesthetic and anti-inflammatory cortisone is then slowly injected into the joint.

IV sedation is not used for a hip injection, and you are not put to sleep for the procedure.

After the Hip Injection Procedure

The hip injection itself only takes a few minutes, but the overall procedure process usually takes longer.

After the hip joint injection, you are encouraged to participate in activities that would typically cause pain if there is a diagnostic reason for the injection.  If your typical pain is improved, then the culprit is likely the hip joint.

Patients may or may not obtain pain relief in the first few hours after the injection, depending upon whether the hip joint is the main source of the patient's pain.

On occasion, the patient may feel numb or experience a slightly weak or odd feeling in the leg for a few hours after the injection.

Patients may continue to take their regular medicines after the procedure.  The one exception is to avoid pain medication within the first four to six hours after the injection so that the diagnostic information obtained is accurate.

Pain Relief After a Hip Joint Injection

Patients may notice a slight increase in pain after a hip injection lasting for several days as the numbing medicine wears off and the cortisone is just starting to take effect.

If the area is uncomfortable in the first two to three days after the injection, applying ice or a cold pack to the general area of the injection site will typically provide pain relief and appears more beneficial than applying heat.

Diagnostic feedback is obtained through tracking pain relief:

• If the hip joint that was treated is the source of the pain, the patient may notice pain relief starting two to five days after the injection.
• If no improvement occurs within ten days after the injection, then the patient is unlikely to gain any pain relief from the injection and further diagnostic tests may be needed to accurately diagnose the patient's pain.

The patient will discuss with the doctor any immediate hip pain relief and will then record the levels of pain relief during the next week. A pain diary is helpful to clearly inform the treating physician of the injection results and in planning future tests and/or pain management treatment, as needed.

Physical therapy is usually recommended after the injection while the numbing medicine is effective and/or over the next several weeks while the cortisone is working.

On the day after the procedure, patients may return to their regular activities. When the pain has improved, return to regular exercise and activities in moderation.

Potential Risks of Hip Injections

Possible side effects and risks from a hip joint injection include:

• Allergic reactions to the medications used
• Infection
• Post-injection flare (joint swelling and pain several hours after the corticosteroid injection)
• Depigmentation (a whitening of the skin)
• Local fat atrophy (thinning of the skin)
• Rupture of a tendon located in the path of the injection
• Bleeding or hematoma (especially if on blood thinners)

Final Thoughts on Hip Injections

Injections of pain-relieving medication directly into the hip joint can be useful for helping diagnose and treat a variety of conditions, such as hip osteoarthritis, labral tears, and/or hip joint problems that contribute to low back pain.

See Why Does My Lower Back and Hip Hurt?

One benefit of a hip joint injection is that if substantial pain relief is achieved, the patient can then make progress in a controlled, gradual physical therapy program for longer term rehabilitation.