The hip joint is the largest joint in the human body and is a weight bearing joint largely responsible for standing, walking, and running. In cases of degenerative arthritis, the cartilage of the hip joint begins to deteriorate and frequently becomes inflamed. Hip joint pain is usually felt in the gluteal muscles and groin of the affected side and can refer down the anterior thigh to the knee. Patients will report increased pain with weight-bearing and hip movement. Typically, lifting the hip to get out of a car or climbing stairs can be very painful. Your doctor can often reproduce the pain with internal and external rotation of the hip.
When antiinflammatories are ineffective or not safe to take, a steroid injection can often times be very effective in not only relieving the pain, but diagnosing the source of pain. In order to inject the hip safely, guidance from ultrasound or fluoroscopy is recommended for this procedure.
This procedure is minimally painful and does not require sedation. Most insurances do not cover anesthesia for joint injections. The patient is placed on their back in the supine position on the Xray table. The skin is prepped with alcohol or betadine. Using Xray, the hip is visualized for approach. A small needle is used to numb the skin over the upper outer thigh. A slightly larger needle is used to inject the joint under Xray guidance. A small amount of contrast is injected to confirm placement within the joint. Any excess joint fluid could be aspirated at this time. A small solution of lidocaine, marcaine, and steroid (Kenalog) is then injected into the joint. There is minimal discomfort felt while injecting the medication. If necessary, the hip joint can be ranged or manipulated to increase spread within the entire joint.
Once the joint has been injected, the patient is allowed to sit up and then stand with assistance. Most patients report immediate improvement in the hip pain due to the effects of lidocaine in the joint. Typically patients are allowed to leave without a driver and return to normal activities as tolerated. Most joint injections last about 3-6 months and results vary depending on the severity of arthritis and degree of obesity. This injection can be performed up to 3 times in a year. If patients are requiring more frequent injections in the hip, there is usually a point where surgical consideration is necessary.