Hip injection

Why might this treatment be considered?

An injection into the hip joint may be considered when pain is thought to arise from within the joint—for example from osteoarthritis—and short-term pain relief may help with daily activity, sleep or participation in rehabilitation. It can also have a diagnostic role: temporary relief from local anaesthetic may help clarify whether the hip joint is the principal source of pain. NICE advises considering an intra-articular corticosteroid injection when other medicines are ineffective or unsuitable, or to support therapeutic exercise. Benefit is variable and usually temporary; for osteoarthritis, NICE describes short-term relief of around 2 to 10 weeks.

What does the procedure involve?

The hip is a deep joint, so the injection is normally performed using ultrasound or X-ray guidance to position the needle accurately. After cleaning the skin, local anaesthetic may be used to numb the area. A needle is passed into the joint and local anaesthetic, corticosteroid, or a combination is injected. X-ray-guided procedures may also use a small amount of contrast to confirm position. The procedure is usually completed as an outpatient or day-case treatment.

Potential benefits

• Temporary reduction in hip pain and inflammation
• Improved comfort for sleep, walking or everyday activities while the injection is effective
• A window in which physiotherapy, exercise or rehabilitation may be easier
• Diagnostic information when the source of pain is uncertain
• Possible postponement of surgery for some patients, although an injection does not reverse arthritis

Reasonable alternatives

• Education, activity modification and pacing
• Physiotherapy and an individual exercise programme
• Weight optimisation where appropriate
• Pain relief or anti-inflammatory medication when medically suitable
• A walking stick or other mobility aid
• Continuing without an injection
• Total hip replacement when symptoms and arthritis are sufficiently advanced and non-surgical measures no longer provide acceptable relief

Important risks and limitations

Every procedure carries risk. The likelihood and importance of each risk vary between individuals.

• The injection may provide little, brief or no improvement
• A temporary increase in pain for 24 to 48 hours (a steroid flare)
• Bleeding or bruising; the risk may be higher with anticoagulant or antiplatelet medication
• Infection within the joint or at the injection site; this is rare but requires urgent medical assessment
• Temporary numbness or weakness from local anaesthetic
• A temporary rise in blood glucose, particularly for people with diabetes
• Facial flushing or temporary menstrual disturbance after corticosteroid
• Skin thinning, loss of fat or a change in skin colour at the injection site, which can occasionally persist
• Allergic reaction to local anaesthetic, steroid, contrast or dressings
• Rare injury to a nearby nerve or blood vessel
• Progression of the underlying arthritis despite treatment
• Repeated corticosteroid injections may have additional local and systemic effects; frequency should be considered individually
• A recent hip injection may influence the timing of future hip replacement surgery and should be disclosed to the treating surgeon

Recovery and expectations

• Arrange suitable transport home and follow the unit’s advice about driving; driving is commonly avoided for 24 hours after the procedure.
• Keep the dressing clean and dry for the period advised and avoid strenuous activity for at least 24 to 48 hours.
• Local anaesthetic relief may wear off after a few hours. The corticosteroid may take several days to reach its full effect.
• A short-lived pain flare can occur. Usual pain relief may be taken if it is safe for you.
• If you have diabetes, monitor blood glucose more frequently for at least 72 hours and seek advice if it becomes difficult to control.
• Seek urgent medical assessment for increasing pain after 48 hours, redness, warmth, swelling, discharge, fever or feeling systemically unwell.
• Record the amount and duration of pain relief, as this can help guide the next consultation and treatment decision.