Hip Joint Injections

A guided injection into the hip joint can settle inflammation, confirm that the hip really is the source of your pain, and buy time before any decision about surgery is made. The injection is carried out with a special needle, with an x-ray machine used to guide it accurately into the correct area.

The substance injected is made up of a local anaesthetic, which blocks pain, together with a medication such as a steroid or hyaluronic acid (for example Ostenil) that reduces inflammation. Mr Chauhan offers the same family of treatments in the knee — see knee joint injections for a comparison of the options.

The procedure

You will be seen by the surgeon the day before or the day of the procedure. This is a good moment to ask any questions. The surgeon may also draw an arrow on you to make sure the correct joint is treated.

An anaesthetic is administered in theatre. This may be a general anaesthetic, where you are asleep, sedation, where you are given medication to make you drowsy, or a local block, where you are awake but the area is completely numbed. You must discuss the choice with the anaesthetist.

Your skin is cleaned with antiseptic and covered with sterile drapes, and you are positioned to allow the surgeon a good view of the area. The surgeon takes an x-ray and guides the needle into place, avoiding important structures. Sometimes a dye that shows up on x-ray is injected and a picture is taken. The surgeon then completes the procedure by injecting the local anaesthetic together with the steroid or hyaluronic acid.

Additional procedures

It may be necessary to carry out additional procedures at the same time, which may include:

• Releasing tightness or dividing a tendon or other structure with the tip of the injection needle, known as a percutaneous tenotomy.
• Manipulating the area to make sure the medication reaches everywhere it needs to, or to free a joint.

Afterwards

When you wake you may feel sore, or feel nothing at all for a while — numbness may be due to a special injection some anaesthetists use. There may be a thick bandage around the injected area. You may be able to go home the same day, but you should discuss this with your surgeon. The physiotherapists may show you some exercises, and it is important to follow these. You will be told about any follow-up appointments. Most of the recovery should be apparent within six to eight weeks.

Risks of a hip injection

Common

• Pain: usually disappears and then returns as the local anaesthetic wears off. Sometimes the pain becomes much worse for a few days and usually takes up to four days to subside. Discuss this with the staff and ask for painkillers if you need them. Even after the procedure you may still have pain.

Less common

• Swelling: occurs when a tenotomy is performed.

Rare

• Nerve damage: a number of important nerves lie around the injection site and may be damaged by the injection or the instruments. Most effects are temporary, and may cause muscle weakness or numbness further down from the site. Because local anaesthetic is injected, the effects can mimic nerve damage, but this usually recovers within 12 to 48 hours leaving no permanent effect.
• Tendon damage: tendons around the joint may be damaged during the procedure, or may become thinned as a result of the steroid itself. This is rare.
• Bleeding: there will inevitably be some bleeding, but it is usually small with this procedure.
• Scarring: the procedure leaves one or two pinhole scars, and you should discuss their position with your surgeon. Wounds can sometimes heal poorly, leading to thickened scars or further surgery.
• Fat atrophy: thinning of the fat can occur with a steroid injection, which may cause a dimple or hollow in the skin.
• Infection: may present as redness, discharge or a temperature around the injection site. A course of antibiotics may be necessary, or very rarely an operation to wash out the area.
• Fracture: this can occur during manipulation of an area. It is rare and every effort is taken to reduce the risk.