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Why inject a hip joint?

Hip joint injection for pain relief, or diagnosis in early arthritis

Injection of local anaesthetic and steroid into an area of inflammation will reduce pain and swelling. Corticosteroids are natural hormones that we all produce and at higher doses artificial steroids have a proven anti-inflammatory effect. By reducing the swelling this may reduce mechanical friction and allow the affected area to heal.

Which conditions are treated by injections around the hip?

Injections outside the hip joint are used to treat:

  • Trochanteric Bursitis
  • Iliopsoas Bursitis
  • Osteitis pubis
  • Adductor Strain
  • Gluteus Maximus Calcific Tendonitis
  • Pubic Symphysitis
  • Meralgia Paresthetica
Injections into the hip joint cavity can be used to confirm the hip joint as the major source of symptoms and for inflammation associated with:

What is injected?

The aim of an injection is to reduce the inflammation in the local area, with the minimum spread of the steroids into the rest of the body. The chemical composition and preparation of the steroid injection can be modified to give a maximal local effect.

  • Triamcinolone Hexactanide: This is not very soluble and therefore persists in the local area with a long duration of activity.
  • Triamcinolone Acetonide: This is a more soluble preparation with a quicker onset of effect, but a shorter duration.
  • Methylprednisolone Acetate: This is soluble with a rapid onset of effect but only 5-6 weeks duration.

Will I need an anaesthetic for the injection?

Those areas closer to the surface and can be injected by feeling the structures through the skin. It is common practice to mix local anaesthetic with the corticosteroid when undertaking superficial injections - one injection and rapid pain relief.

The hip joint cavity is deep under several layers of muscle, and is more difficult to inject. To be sure a deep injection is in the right spot some form of image guidance is required, either with a portable x-ray machine (image intensifier) or an ultrasound machine. For this type of injection some local anaesthetic into the tissues before probing deeper is usual.

Only in the rare cases, when both hips need injection at the same time, is a general anaesthetic necessary.

Can I drive home afterwards?

Yes, it is not normally necessary to rest the joint. Occasionally patient feel faint after injections and my need help - you know who you are! If you have had a general anaesthetic you will not be able to drive home.

What are the possible complications?

There can be side effects following an injection. The commonest (3-5%) is an inflammation of the joint as a reaction to the insoluble crystals of steroid. This will settle over 2-3 days as enough steroid dissolves to cure the inflammation.

In patients with pigmented skin these injections can cause permanent localized loss of the pigment.

The most serious local complication is an infection in the area injected. This is very rare (<1%) and causes fever with local pain and swelling.

Occasionally (1-2%) the steroid may enter the circulation and cause problems. In healthy individuals this is limited to a "flushing reaction", the red face only last 24-48 hours. These rare reactions are the reason that injections are not recommended for women during pregnancy or lactation. Patients with life threatening brittle diabetes should also avoid steroids when possible.

How long will the injection last?

We ask patients to keep a diary grading their pain from 1-10 , ideally for 2 weeks before and two weeks after the injection for comparison. The chemical activity of the corticosteroid dissipates over time, between 6-12 weeks. Hopefully by reducing swelling in the tissues the relief of painful inflammation will out-last the activity of the injection.

How frequently can the injection be repeated?

There is debate about the effect of steroid injections given into joints and the progression of arthritis. As the steroid slows down the inflammatory cells it also slows down the bodies normal repair processes. Current guidance is to set a maximum of 3-4 injections in any one joint per year. This is not likely for the hip joint because recurrent symptoms after 1-2 injections probably means a different treatment is necessary.

Injections it to the soft tissues around the hip should also be limited perhaps to 2-3 injections per year as there is a risk of tendon/ligament rupture with over exposure to steroids.

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