A hip injection is a non-surgically invasive procedure that helps reduce the inflammation and pain caused by overactivity or frequent activities such as squatting, standing for long periods, climbing stairs, running etc., that can cause friction of soft tissue around the hip. It should be combined with a physiotherapy rehabilitation program to modify activities and prevent reoccurrence. If the damage inside the joint is more severe, then the hip injection effects will be short-term; however, the therapy program will still help in the long term, especially if a more definitive surgical procedure is required later.

Anybody experiencing pain in the hip region who has inflammation of either the joint ( intra-articular) or soft tissues surrounding the joint ( extra-articular ) is a candidate for injection. Diagnosis of the condition will come with a thorough history of the condition, examination of the joint and appropriate imaging investigations, e.g. X-ray and MRI scan.

The hip joint can become painful through injury and wear and tear; if the structures inside the joint ( intra-articular) are damaged, e.g. labral tearing in the condition of femoroacetabular impingement (FAI) or articular cartilage damage in the case of arthritis (OA) then hip injection can be greatly beneficial. However, we perform this more often in FAI than OA.
Soft tissues around the hip can become inflamed due to overactivity or compensation due to FAI or OA. Different structures can become inflamed tendons, bursae (a fluid-filled sac designed to prevent tendon rubbing against bone) and muscles, causing a host of conditions such as:

• gluteal tendinopathy
• psoas tendinopathy
• iliotibial band syndrome
• trochanteric bursitis
• sub-gluteal bursitis
• psoas bursitis
• piriformis muscle syndrome
• quadratus femoris inflammation.

A steroid is essentially an anti-inflammatory and is the only thing we would inject into the soft tissues ( extra-articular). Its success rate in calming inflammation is high, 85-90%; however, its effects last only three months. There is a lot of research, and current outcome work in knees has demonstrated the option for other injectables. The following list is for intra-articular only:

Hyaluronic Acid – naturally occurring in joint fluid where I inject after every arthroscopy to replace the joint fluid that has been washed out. It should be of high molecular weight.
Platelet Rich Plasma (PRP) – can have an anti-inflammatory effect, although success is 50:50; however, 2nd generation products are showing much higher success rates of 70% out to 2-3 years from a single injection.
Hydrogels – just launched in the UK, and outcomes show 70% success out to 2-3 years from a single dose.

After the intra-articular procedure, I will put a plaster on the injection site. You will be taken to recovery, then back to your room, and you should be able to leave the hospital after you have eaten and drunk. This is usually 1-2 hours after the procedure, and we request you are escorted home given you would have been given a low dose anaesthetic agent. You may feel slightly sore for a few days; however, it may take two weeks for the steroid to work and to note a reduction in pain. We advise starting therapy after two weeks and continuing for 2-3 months. I will see you in the clinic for the follow-up at 6 and 12 weeks after the procedure.
Extra-articular procedures are performed by the radiologist in the imaging department and are an outpatient procedure.

Hip injections have a very low risk of adverse effects. Some of the side effects of this procedure include –

• Bleeding at the injection site,
• Inflammation and flare-ups at the injection site,
• Infection at the injection site,
• Discomfort at the injection site.

Recovery from the procedure is very quick, and you should be back walking and feeling confident within 12-24 hours; your physiotherapist will advise you to perform passive exercises along with strengthening and stretching exercises to regain strength in your muscles and reduce pain in your hip region; however, you should take into consideration some of the tasks listed below:-

Exercise – Resume your regular exercise plan after two weeks, but consult your therapist if you are returning to weight-bearing workouts,
Work-life – Assuming you are not at risk of further injury, you may return to work within 24 hours of your hip (block) injection. Ask to be given light duties if your employment involves heavy lifting,
Driving – You can return to driving after 24 hours but always ensure you can perform an emergency stop before getting back behind the wheel,
Flying – Flying is not an issue, even if you are flying on the same day as the procedure.

With all procedures I perform, I always insist on working with a therapist to ensure better results. This can be included in your treatment and recovery plan.
Ideally, therapy treatment should extend up to 12 weeks after hip (block) injections to help build hip and pelvic strength. Again, this ensures our patients get the best results and helps keep the joints healthy.

Hip Injections are performed as a diagnostic and therapeutic injection, meaning I can get a better idea of your issue once this procedure has been performed. There is a maximum dose of steroid that can be given, so sometimes patients have very significant inflammation, and the steroid is not enough to calm it down; therefore, a repeat injection may be required. Also, patients may well have both intra and extra-articular sources of pain, so two areas may need to be treated, which we advise doing at separate sittings to confirm a more accurate diagnosis. However, we recommend the intra-articular injection first as the joint tends to be the source. Pain arising from elsewhere could indicate issues relating to the lower back, knee and, in rare cases, the groin and buttocks. But, again, a hip block injection can help illuminate any of these underlying issues.