Hip Joint Injection
Arthritis

What is arthritis?

Arthritis is a condition that causes pain and stiffness of the joints. It sometimes also causes redness or swelling. In severe cases, joints may become deformed.

There are different kinds of arthritis. Two common forms are osteoarthritis and rheumatoid arthritis. Symptoms of osteoarthritis begin to appear by middle age. Most people over age 60 have some osteoarthritis, although they may not have symptoms. Rheumatoid arthritis usually starts in early adulthood or middle age. Both osteoarthritis and rheumatoid arthritis are three times more common in women than in men.
Examples of other forms of arthritis include gout and arthritis that occurs after an injury or with certain infections, such as gonorrhea.

How does it occur?

Osteoarthritis causes the breakdown of the cartilage cushioning in joints. It can also cause the bones in joints to become rough. Osteoarthritis occurs most often in weight bearing joints, such as the spine, knees, and hips. It also often affects the fingers.

Rheumatoid arthritis affects the lining of the joints. It is thought to be an autoimmune disease. This means that the body’s defenses against infection attack the body’s own tissue. It causes inflammation (redness and swelling), stiffness, and deformity, especially in the joints of the hands, arms, and feet.

What are the symptoms?

Possible symptoms of arthritis include:
  • Mild to severe pain in the joints
  • Red, swollen joints
  • Stiffness and limited movement, especially in the morning
  • Deformed joints.

How is it diagnosed?

Your health care provider will review your medical history and examine you. He or she may order blood tests and x-rays to confirm the diagnosis and measure the extent of the disease.

How is it treated?

The goal of treatment is to keep the joints working properly by:
  • Relieving pain and stiffness
  • Reducing any swelling.

Acetaminophen (Tylenol) is usually the first choice for medicine to control pain. Other medicines, including anti- inflammatories (such as aspirin, ibuprofen, and COX2 inhibitors) are often used. These medicines control the chemicals that cause swelling. Your health care provider will prescribe the medicine that is best for the kind of arthritis you have.

Controlling your weight will reduce strain on weight bearing joints. Physical therapy can help keep your muscles strong and movement of your joints as normal as possible.
If the above measures have not made a significant reduction in your pain or increase in your functional level, your physician may recommend a steroid injection. Steroid injections into the hip joint, as well as the knee and shoulder joints, have been done for years. The goal is to inject a long-acting steroid medication along with an anesthetic agent to try and reduce swelling, inflammation, and pain. Since the hip joint is located in the groin area and it is difficult to confirm that you are in the joint, this procedure is done under x-ray guidance. Through the use of fluoroscopy, which is a special type of live x-ray, a physician is able to verify placement of the needle inside the hip joint and appropriate insertion of medication to treat your pain problem. If steroid injections offer you six months or longer of relief, they can be repeated on an as-needed basis. If this fails to give you relief, other options may include synthetic injectable medications such as Synvisc. These are also injected under x-ray guidance.
If your hips or knees are severely damaged, your health care provider may recommend surgically replacing them.

How long will the effects last?

If you have arthritis, you will probably have it for the rest of your life. How often you have symptoms of arthritis depends, at least in part, depends on the type of arthritis you have. You might be reminded of the arthritis every time you use the affected joints. Or you may have periods when you have symptoms and then other times when you do not.

How can I take care of myself?
  • Take the medicine your health care provider recommends for controlling your arthritis.
  • Follow your provider’s advice for weight control if you are overweight.
  • Do the exercises recommended by your health care provider or physical therapist.
  • Keep your body healthy by eating a healthy, varied, low-fat diet.

What can I do to prevent arthritis?

No one knows how to prevent arthritis. However, it is a condition that can usually be managed by taking regular medicine, protecting the affected joints, and keeping the joints mobile.

How does a hip injection work?

The injection of steroids directly into the hip is thought to aid in reducing inflammation.

The other belief is that the corticosteroids act like a local anesthetic and block the pain long enough to allow the body to begin the process of repairing itself.

The chief effect of an injection is to reduce pain, but the effect differs from person to person. Most patients will receive good relief for months after the injection. Some patients do not experience any pain relief and may, in fact, suffer an increase in pain and/or other symptoms as detailed later. The goal of your injection is to provide at least 50-75% relief so you can begin an appropriate exercise program and return to normal activities/work.
Y
ou will then be allowed to recover and return back home. In general, most patients get a good relief initially from the numbing medication. If this does not give you relief immediately, you still have a great chance of getting a good steroid response which takes 1-3 days to take effect. The peak effect of your injection should be 5-7 days after your injection, and you should follow up with your referring physician for any future follow-up recommendations.

How is a hip injection administered?

You will be helped to position yourself on a special bed designed for these types of procedures. A Hep-Lock IV (if you have elected to take sedation) will be inserted into a vein for the administration of any IV medication, if needed. Your doctor will inject local anesthetic into the skin and underlying tissues to decrease the discomfort of introducing the needle.

Once the local anesthetic is working, the needle is advanced into the joint space, using the bones as landmarks and a
fluoroscopy unit (a type of x-ray) to ensure that the needle is in the right place.

When the needle is in the joint space, a syringe containing the corticosteroid solution is connected to the needle. After making sure that the needle is not in a blood vessel by the use of a contrast agent, your doctor will inject the solution slowly and will ask you to describe how you are feeling while the solution is being injected.

You may briefly feel pins and needles in the legs. If the needle touches a bone you will feel a short local pain. You should tell your doctor about these feelings.
The corticosteroid will be injected in the form that may include a saline solution and/or a local anesthetic. The dosage and the volume of the steroid and other components will vary according to the doctor’s judgment.

What are the risks of a hip injection?

With any operation or injection procedure there are risks. In the case of hip injections these risks are small.
There are a variety of side effects and complications, most of which relate not to the steroid itself, but to the way the injection is given.

The most common side effect is a temporary increase in pain. It occurs in about 1% of steroid injections and appears to be related to the volume of fluid injected into the space.
As with any injection through the skin, it is possible for bacteria to gain entry causing an infection. The risk of this with an injection is very small. Bleeding is also a risk of this procedure, which is why you are counseled to stop taking aspirin products, anti-inflammatory products, and blood thinners.

Sometimes the patient’s blood pressure falls at the time of the injection. If so, your doctor will use the IV inserted prior to the beginning of the procedure to stabilize the blood pressure using intravenous (IV) fluids and/or medication if necessary.

Repetitions

You are most likely to experience the best relief with one or two injections. It is unreasonable to undergo more than two injections if none has provided any relief. Even if steroid injections provide relief, only in exceptional cases would more than three injections be justified within a three-month period.

If you have any questions about the procedure or information you have just read, please ask your doctor who will be more than happy to answer any questions you may have.