The most common hip arthritis is osteoarthritis. This condition is characterised by the progressive loss of cartilage in the joint. As the cartilage is worn, bone is exposed, leading to inflammation and pain. Most hip arthritis occurs in people over the age of 50. 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 

women with greater trochanteric pain syndrome and hip arthritis

Common symptoms include pain in the hip or groin, which is often worse in the morning and after activity. Pain may sometimes present in the knee or upper thighs, frequently confusing doctors. Moreover, the hip may feel stiff and lose its range of motion. As the disease progresses, people may find that they walk with a limp.

It is essential to understand that progression is not necessarily steady. Some cases do not progress at all. Moreover, maintaining a fit and active lifestyle reduces the chances of disease progression.

We’d like to suggest that you see a doctor for a complete assessment to determine other possible causes of your hip pain. These different causes include pain from the lumbar spine, sacroiliac joint degeneration,  hip tendonitis,  hip impingement and frozen hip. 

A plain hip X-ray usually confirms the diagnosis and rules out other diseases. If an X-ray is normal, additional imaging, such as an MRI, may be helpful. However, in most cases, these more expensive tests are not necessary.

Causes of hip arthritis

Overall, there are numerous causes and risk factors that contribute to the development of hip arthritis. Some of these causes include:

  • Age
  • Genetics
  • Obesity
  • Fractures to the hip joint

What to do for arthritis in the hip

Overall, the treatment of hip arthritis should begin with simple steps and then progress to more invasive measures, ultimately leading to surgery. Not all these steps will be appropriate for every person. However, it would be best to explore these safer options, as many are effective and reliable.

  • Weight Loss: Probably the most necessary treatment, but also underrated. If you lose weight, you have less load on the hip joint. Additionally, reducing fat mass helps decrease inflammation in the joints.
  • Activity modification: In some cases, reducing or stopping activities such as football or running can help manage pain.
  • Exercise: 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 your diet: A healthy diet is conducive to weight loss, but a diet rich in antioxidants will also help lower inflammation in the body, including the hip joint.

Can I run with hip arthritis?

Generally, we recommend exercise therapy to help with symptoms and exercise tolerance. Over 12 high-level studies show that a formal exercise program combining aerobic, resistance, and balance training improves hip symptoms.

Occasionally, flare-ups of pain occur within the first six weeks of starting a new program. However, don’t be discouraged 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 as you would 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 help alleviate pain and improve 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 for treating 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 remains the gold standard treatment for hip replacement. It has an over 90% success rate. In this surgery, we remove and replace cartilage with a metal and plastic implant.
  • Hip resurfacing: Some younger patients opt for hip resurfacing rather than total hip replacement. There are advantages to resurfacing, including reduced risk of dislocation 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, a study in the UK found that a cortisone shot into the hip joint, guided by ultrasound, improved pain for four months compared to simple education. Additionally, cortisone injections were relatively safe when performed by skilled hands. On the contrary, another study found that 50% of patients with hip arthritis experienced short-term benefits (lasting approximately two weeks), while 30% obtained medium-term relief and 20% experienced 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.

Additionally, be cautious about receiving a cortisone injection immediately 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 joint function. 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 Durolane study on hip arthritis found excellent results following a single ultrasound injection. Another study found that 75% of people who had a Durolane injection for arthritis were satisfied.

However, we must be cautious 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 should inject hyaluronic acid with ultrasound guidance to enhance accuracy and minimise 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 from the red blood cells and the white blood 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. More significant improvements occurred with one injection (rather than multiple) and leucocyte-poor PRP.

Second-generation PRP systems have recently been released on the market, offering higher platelet concentrations and doses. Studies on knee osteoarthritis suggest better results with higher concentrations and doses of platelets. These systems involve a double spin and require more time. An example of a second-generation system is Arthrex ACP Max. 

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, there is no substantial evidence to support the use of 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 recommend 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 also affect the upper thighs, buttocks, or even the knee. Therefore, you must see a doctor who is experienced in musculoskeletal conditions so that the hip joint is not overlooked as a cause of pain.

Can you drive after a hip injection?

Generally, we recommend avoiding 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 anaesthesia.

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 recommend wearing loose-fitting 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 to consult your doctor about these options.

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