The most common hip arthritis is osteoarthritis. This condition is characterised by progressive loss of the cartilage of the joint. As the cartilage is worn, bone is exposed, leading to inflammation and pain. Most hip arthritis occurs in people above the age of 50 years. However, some younger people in their 20s and 30s develop this condition early. In complex cases, we consider injections for hip arthritis. So, what are your options for injections for hip pain?
Causes
In general, we think there are many potential causes of hip arthritis. First, increased age and weight are the leading causes. Other possible causes include traumatic injuries to the hip joint and abnormally shaped joints such as hip impingement or hip dysplasia. Finally, there may be a genetic influence, meaning osteoarthritis runs in the family.
Symptoms
Common symptoms include pain in the hip or groin and worse in the morning and after activity. In some cases, pain may present in the knee, or upper thighs, often confusing doctors. Moreover, the hip may feel stiff and lose its mobility. As the disease worsens, people might find they walk with a limp.
It is essential to understand that progression is not necessarily steady. Some cases do not progress at all. Moreover, keeping fit and active reduces the chances of progression.
We suggest you see a doctor for a full assessment to rule out other causes of hip and groin pain. Examples of other causes include pain from the lumbar spine, sacroiliac joint degeneration, and hip tendonitis.
A plain hip X-ray usually confirms the diagnosis and rules out other diseases. Other imaging, such as MRI, might help if an X-ray is normal. However, in most cases, these more expensive tests are not necessary.
Causes of hip arthritis
Overall, there are many causes and risk factors for developing hip arthritis. Some of these causes include:
- age
- genetics
- joint abnormalities such as hip impingement or hip dysplasia
- obesity
- fractures to the hip joint
What to do for arthritis in the hip
Overall, treatment of hip arthritis should start with simple steps and then progress to more invasive steps leading up to surgery. Not all these steps will be appropriate for every person. However, it would be best if you explored these safer options, as many are effective.
- Weight Loss: Probably the most necessary treatment but also underrated. If you lose weight, you have less load on the hip joint. Also, reducing fat mass decreases inflammation in the joint.
- Activity modification: In some cases, reducing or stopping activities such as football or running can help manage pain.
- Exercise: We know that building the strength of the muscles around the hip and pelvis will reduce the load on the diseased hip joint. Tai Chi and Yoga are thought to be very effective for hip arthritis.
- Improve diet: A healthy diet is conducive to weight loss, but a healthy diet rich in antioxidants will lower inflammation in the body and the hip joint.
Can I run with hip arthritis?
Generally, we recommend exercise therapy to help symptoms and exercise tolerance. Over 12 high-level studies show that a formal exercise program consisting of a combination of aerobic, resistance, and balance training improves hip symptoms.
Occasionally, flare-ups of pain occur within the first six weeks of starting a new program. But don’t be put off by episodes of short-lived low-level pain.
Exercises that help hip arthritis include resistance exercises, Yoga, swimming, cycling, and golf.
Similarly, it would be best to think of running like other exercises. We allow running if the pain during or after running is low-level and lasts less than 24 hours.
More invasive interventions
Next, more invasive interventions must be considered if simple measures do not control pain.
Injections into the hip joint can improve pain and function. As outlined below, there are several options for hip joint injections for pain.
Surgery is often an option for those people who struggle with pain despite a period of non-invasive treatment. Options for surgery include:
- Hip arthroscopy: Keyhole surgery is generally NOT recommended to treat hip arthritis. If we do keyhole surgery for hip arthritis, we know these people do worse and often go on to replacement surgery earlier than those who do not.
- Total hip replacement: This is still the gold standard treatment for hip replacement. It has an over 90% success rate. We remove and replace cartilage with a metal and plastic implant in this surgery.
- Hip resurfacing: Some younger patients opt for a resurfacing rather than a total replacement. There are advantages to resurfacing, including less dislocation risk and a more straightforward revision procedure. However, over 60 years, women and those with inflammatory arthritis should consider a standard hip replacement.
More about injections for hip pain
Generally, hip joint injections for pain form a small part of the overall management of hip arthritis. Nevertheless, injections are less invasive than surgery and help many people. So, what are the options for injections for hip pain?
Cortisone
Cortisone is a potent anti-inflammatory that reduces inflammation in a hip joint. Recent studies suggest that cortisone provides a short-term effect. For example, one study in the UK found that a cortisone shot into the hip joint directed by ultrasound improved pain for four months compared to simple education. Also, cortisone injections were relatively safe if done with good hands. On the contrary, another study found that 50% of patients with hip arthritis derived short-term benefits only (about two weeks), while 30% obtained medium-term relief and 20% had no relief.
However, there are increasing concerns that cortisone can worsen arthritis. It should only be used if hip pain is severe and you need immediate relief.
Also, you should be cautious about having a cortisone injection just before a hip replacement. Recent research suggests an increased risk of infection if a replacement is done within three months of injection. Also, multiple cortisone injections increase the risk of worse hip joint arthritis. As a hip replacement infection can be devastating, we must avoid injecting cortisone before surgery.
Hyaluronic acid
Hyaluronic acid is a natural substance in joints, bones, and tendons.
Injecting hyaluronic acid into a diseased joint reduces inflammation and improves the function of the joint. We suspect it works by enhancing the synovial fluid in the joint. However, unlike cortisone, it is not harmful to the joint surface.
Nevertheless, there is much debate about the usefulness of hyaluronic acid injections for hip arthritis. Recent studies suggest a small effect, which may be no different from other drugs. One reason for the smaller effect is the type of hyaluronic acid used. Using a high molecular weight and high cross-linked hyaluronic acid is better. An example of a high molecular weight hyaluronic acid is Durolane. A study using Durolane in hip arthritis found excellent results for one ultrasound injection. Another study found that 75% of people who had a Durolane injection for arthritis were satisfied.
However, we need to be careful about hyaluronic acid injections. If we miss the joint and inject it into the soft tissue, we know that some people might develop a severe reaction. Overall, you need to inject hyaluronic acid with ultrasound guidance to improve accuracy and reduce the risk of a reaction.
Platelet-rich plasma
Platelet-rich plasma or PRP, comes from whole blood. The blood is spun in a centrifuge, separating the plasma for the red and white cells. This plasma, containing a high concentration of platelets, is injected into the hip joint. We think that PRP works by changing the environment of the hip joint.
While there is good evidence for PRP in knee arthritis, the data is lacking for hip arthritis.
A recent review found that one PRP injection provides at least two months of pain relief. Greater improvements occurred with one injection (rather than multiple) and leucocyte-poor PRP.
Stem cells
Stem cells are the new rage in the musculoskeletal world. We obtain these cells from bone marrow or fat through a short medical procedure. The stem cells are then extracted from other cells and injected into the hip joint. Unfortunately, no substantial evidence has supported stem cells for hip arthritis.
Other frequently asked questions about hip injections for arthritis:
What is the best injection for hip pain?
It depends on your pain presentation. We recommend a cortisone injection for good short-term relief of severe and excruciating pain. However, we advise a high molecular weight hyaluronic acid such as Durolane for your long-standing grumbly pain.
Can you have a steroid injeciton before a hip replacement?
Yes. However, recent studies suggest that having a cortisone injeciton close to a hip replacement increases the risk of surgery. Therefore, we recommend avoiding a steroid injection within three months of a total hip replacement.
Can hip arthritis refer to other areas apart from the hip or groin?
Yes. Pain from hip arthritis can refer to the upper thighs, buttocks, or even the knee. So, you must see a doctor experienced in musculoskeletal conditions so you don’t miss the hip joint as a cause of pain.
Can you drive after a hip injection?
Generally, we suggest you avoid driving directly after a hip joint injection. However, driving is often allowed the next day if you can move without pain.
Are you put to sleep for a hip joint injection?
No. Generally, you don’t need to be put to sleep if you have an ultrasound-guided hip joint injection. However, injections done with X-ray guidance are ususally done with sedation or, in some cases, general anaesthetic.
How soon can I exercise after a cortisone injection in the hip?
Generally, we recommend you rest your hip for a few days. You should avoid excess walking within 72 hours after a hip joint injection. After seven days, you can resume more intense exercise, such as cycling and crosstraining. Generally, after ten days, you can continue running. P
What do I wear for a hip joint injection?
We suggest you wear loose pants and underwear for a hip joint injection. As sterility is paramount, you must keep your clothing away from the injection site.
Final word from Sportdoctorlondon about injections for hip arthritis
Hip arthritis can be debilitating for most active people. Therefore, it is essential to try simple treatments first. We recommend at least three months of rehab before considering other interventions. Notwithstanding the general lack of evidence, we think a trial of a hyaluronic acid injection or 1-2 PRP injections would be reasonable. It would be best if you spoke to your doctor about these options.
Suffering with osteoarthritis in the hip
I am suffering with osteo arthritis jn my hip and knee. The hip pain is so eawsxcruciating that I cry every day with the pain, especially in the mornings when I wake up, or when i have been resting, and then I get up. I take 8 co-codamol tablets daily, which makes me sleepy. My knee is also very swollen, but the pain has subsided. I am
Waiting to see a doctor in orthopaedics at the hospital, my G.P. referred me about 3 months ago
I know there is a long waiting list, but there’s not much more I can do, but wait, hope and pray. I am going to mention to my G.P about the injections for the hip