What Are Your Options If a Hip Injection Doesn’t Work?

When a hip injection fails to relieve your pain, you still have a wide range of options, from reconsidering the diagnosis itself to trying different types of injections, structured exercise, nerve-targeted procedures, and surgery. Roughly one in five people who receive a corticosteroid hip injection get no meaningful response at all, and among those who do feel better initially, the relief often fades within weeks. That doesn’t mean you’re out of options or headed straight for a hip replacement. The path forward depends on why the injection didn’t work, and there are more forks in that road than most people realize.

How Often Hip Injections Fall Short

Corticosteroid injections into the hip joint are one of the most commonly offered treatments for hip osteoarthritis and related conditions. They can provide fast, sometimes dramatic pain relief, but the results are inconsistent and often temporary. In one study of 82 patients who received corticosteroid hip injections, about 20% showed no response at all, roughly half had only an immediate response that faded, and about a third maintained continued relief.¹ So the injection “not working” is actually the most common single outcome if you define success as lasting relief.

This means that if your injection wore off quickly or never kicked in, your experience is closer to the norm than the exception. The question then becomes: what’s next?

Reconsidering the Diagnosis

Before moving to more aggressive treatments, it’s worth asking whether the pain is actually coming from your hip joint. This sounds obvious, but the hip and the lower spine share overlapping pain referral patterns, and distinguishing between the two is harder than you’d think. People with both hip and lumbar spine problems commonly report low back pain that radiates to the buttock, groin, thigh, and sometimes the knee, making it easy for the real source to be misidentified.²

If your hip injection didn’t help, one possibility is that your hip joint isn’t the main pain generator. Your doctor might use a diagnostic injection, a separate procedure where a local anesthetic is injected directly into the hip under imaging guidance. The idea is simple: if numbing the joint makes the pain go away temporarily, the problem is in the hip. If it doesn’t, the pain is likely coming from somewhere else. A meta-analysis of studies on this technique found that it’s quite good at confirming hip-origin pain, with pooled sensitivity around 97% and specificity around 91%.³ Physical examination techniques can also help sort out whether the hip or the spine is the main culprit.⁴

Getting this distinction right matters because treating the wrong joint is an exercise in frustration. If your pain is primarily spinal, no amount of hip-directed therapy will fix it, and vice versa.

Trying a Different Type of Injection

If corticosteroids didn’t work or wore off too fast, your doctor might suggest a different injectable substance. The two main alternatives are hyaluronic acid and platelet-rich plasma.

Hyaluronic acid (HA) is a thick gel-like substance naturally present in joint fluid. The logic behind injecting more of it is to lubricate and cushion the joint. In the hip, though, the evidence is underwhelming. A randomized trial comparing HA, corticosteroid, and saline injections in hip osteoarthritis found that HA’s effect over saline was modest and not statistically significant.⁵ Most professional guidelines now recommend against HA injections for hip osteoarthritis.⁶

Platelet-rich plasma (PRP) has attracted more enthusiasm. PRP is made from your own blood: a sample is spun in a centrifuge to concentrate the platelets and growth factors, then injected into the joint. One randomized controlled study found that PRP injections produced significantly lower pain scores than HA at six months, and the benefit held more steadily out to 12 months.⁷ A meta-analysis confirmed that PRP reduces pain compared with baseline, with the strongest effect in the first couple of months. Interestingly, a single PRP injection appeared to outperform multiple injections, and formulations with fewer white blood cells seemed to work better than those with more.⁸

That said, not every review reaches an optimistic conclusion. A systematic review of five trials found that while PRP improved outcome scores, there was no clear advantage over HA alone, and the authors felt they couldn’t recommend PRP for hip osteoarthritis based on existing data.⁹ PRP is also not typically covered by insurance for this indication. Still, for people who haven’t responded to corticosteroids and want to try something before surgery, PRP represents a reasonable middle-ground option with a relatively low risk profile.

Physical Therapy and Exercise

If you’ve been relying mainly on injections, structured exercise deserves a serious look. It’s easy to dismiss “do your exercises” as unhelpful advice when you’re in real pain, but the evidence for hip-specific training programs is solid enough that virtually every clinical guideline recommends it as a core treatment for hip osteoarthritis.

A pilot trial of a 12-week exercise program for people with hip osteoarthritis found that participants achieved about a 35% reduction in pain scores on average, along with a 20% gain in leg strength and a 30% improvement in hip extension range of motion.¹⁰ Those numbers came with wide individual variation, which is an honest reflection of reality. Some people respond dramatically to exercise; others get modest benefit. But unlike injections, exercise has no ceiling on how many times you can repeat it, and the side effects are generally positive.

The most effective programs tend to combine strengthening (especially for the muscles around the hip and thigh), flexibility work, and some form of aerobic conditioning. A physical therapist who specializes in hip problems can tailor a program to your specific limitations and monitor your progress.

Medications and Weight Management

Anti-inflammatory drugs remain the most broadly supported medication for hip osteoarthritis pain. NSAIDs like ibuprofen or naproxen, whether taken orally or applied topically, are recommended by most professional societies as a first-line option. Acetaminophen and tramadol can provide short-term relief, though they’re considered weaker options. Opioids and glucosamine are generally recommended against for this condition.⁶

Weight loss deserves a mention alongside medications because excess body weight amplifies hip pain through both mechanical loading and systemic inflammation. Research has found a dose-dependent relationship between weight loss and symptom relief in hip osteoarthritis: the more weight lost, the greater the improvement. Even modest weight loss can meaningfully reduce the forces passing through the hip joint with every step.

Nerve-Targeted Procedures

If the joint itself is the confirmed source of your pain but injections into the joint aren’t helping, one option is to target the nerves carrying pain signals from the hip rather than the joint structures themselves. Two broad approaches exist: nerve ablation and neuromodulation.

Nerve ablation uses heat, cold, or chemical agents to destroy or disable the small sensory nerve branches that supply the hip joint capsule. The advantage is that it leaves the joint mechanically intact while interrupting the pain signal. A study comparing two ablation approaches found that targeting both the front and back nerve branches of the hip provided better and more durable relief than treating the front alone, maintaining good pain control at six months.¹¹

Neuromodulation takes a different approach: instead of destroying nerves, it uses electrical stimulation to override or quiet pain signals. Case reports describe using peripheral nerve stimulators placed near the femoral nerve branches to treat chronic hip pain that hasn’t responded to other therapies.¹² In one case, a temporary stimulator targeting the trochanteric branch of the femoral nerve produced complete resolution of hip pain during the 60-day treatment period. When pain returned after the temporary device was removed, a permanent implanted stimulator targeting the dorsal root ganglion achieved roughly 75% pain reduction with lasting functional improvement.¹³ These are still emerging techniques supported mainly by case reports rather than large trials, but they represent a real option for people with pain that resists everything else.

Arterial Embolization

One of the newer options on the map is transarterial embolization, a procedure borrowed from interventional radiology. The idea is that chronically painful joints develop abnormal new blood vessels that carry inflammatory mediators and nerve fibers. By threading a catheter into the small arteries feeding the hip and blocking those vessels with tiny particles, the procedure aims to reduce both inflammation and the pain signals traveling alongside those blood vessels.

Early results are encouraging. A pilot study found that pain scores dropped from about 10 out of 10 to 2 at six months, with significant improvements in stiffness and physical function.¹⁴ A larger follow-up study of 41 patients showed that pain scores dropped roughly in half at 12 months, with improvements across all functional domains and a favorable safety profile.¹⁵ Another study tracking patients for 12 months reported clinical success in about 73% of cases.¹⁶

This procedure is still considered investigational for hip pain, and the studies so far are relatively small without long-term data beyond a year. But it’s a genuinely new category of treatment that fills a gap between “injections didn’t work” and “you need a hip replacement.” It’s minimally invasive, performed as an outpatient procedure, and doesn’t burn any bridges for future surgery.

When Surgery Becomes the Right Call

If conservative and intermediate treatments haven’t brought adequate relief, surgery enters the conversation. The two main surgical categories for hip pain are arthroscopy and hip replacement.

Hip arthroscopy is a minimally invasive procedure that uses small cameras and instruments inserted through tiny incisions. It’s best suited for specific structural problems like labral tears or femoroacetabular impingement, the condition where bone spurs at the rim of the hip socket or femoral head create painful pinching. One useful finding: patients who responded well to a diagnostic anesthetic injection before surgery had significantly better arthroscopic outcomes at one year than those who didn’t.¹⁷ That’s a practical takeaway: the diagnostic injection described earlier doesn’t just tell you where the pain is coming from, it can also predict how well you’ll do with arthroscopic surgery.

Some surgeons now combine arthroscopy with biologic injections. In patients with labral tears and early arthritis, hip arthroscopy with bone marrow aspirate injection showed similar two-year improvement to arthroscopy in patients without arthritis, though the group with arthritis had a somewhat higher rate of eventually needing a hip replacement.¹⁸

Total hip replacement remains the definitive treatment for end-stage hip arthritis when other approaches have been exhausted. It is one of the most successful operations in modern medicine, with high rates of pain relief and functional restoration. For younger patients, hip replacement is considered appropriate when conservative treatments and bone-preserving surgeries have failed to improve symptoms.¹⁹

Timing Surgery After Injections

If you’re leaning toward hip replacement, the timing relative to your last corticosteroid injection matters more than many people realize. Multiple studies have found that getting a hip replacement too soon after a steroid injection raises the risk of postoperative infection.

One large study found that the infection rate was significantly higher when hip replacement was performed within three months of a corticosteroid injection, with roughly twice the odds of infection compared with patients who hadn’t received a recent injection.²⁰ A more recent analysis confirmed this pattern, showing that injections within three months of surgery carried about 2.6 times the risk of periprosthetic joint infection, while injections given three to six months before surgery did not show a statistically significant increase.²¹

There’s also a dose-dependent component. Research has shown that each additional injection in the three months before surgery incrementally raises infection risk, and an injection within one month carries higher odds than one given four months out.²² The practical takeaway: if you and your surgeon are planning a hip replacement, try to allow at least three months (and ideally longer) between your last corticosteroid injection and the surgery date.

Risks of Repeated Corticosteroid Injections

While you’re deciding what to do next, it’s worth understanding why “just keep getting injections” may not be a safe long-term plan. A systematic review found that repeated corticosteroid hip injections carry risks that include rapidly progressive osteoarthritis, femoral head collapse, and avascular necrosis (where bone tissue dies due to disrupted blood supply).²³ These complications were seen even in patients without pre-existing arthritis, though they were more common in those who already had joint disease.

This is particularly important to know if your corticosteroid injection provided partial or short-lived relief and you’re tempted to schedule another round. One or two injections spaced well apart carry relatively low risk, but the evidence suggests that stacking multiple injections over a short period is where the danger escalates, both for the joint itself and for the infection risk if you eventually need surgery.

When the Problem Is How Your Nervous System Processes Pain

There’s one more scenario worth understanding, especially if nothing seems to work. Some people have a condition where their central nervous system amplifies pain signals, a phenomenon researchers call nociplastic pain. It has been identified in more than a third of patients being evaluated for hip and knee arthritis, and many of these people don’t carry a formal diagnosis of fibromyalgia or any other chronic pain syndrome.²⁴

This matters because patients with nociplastic pain tend to get less relief from surgery than other patients, use more opioids afterward, and report less functional improvement. If your pain has features suggesting central sensitization, like widespread tenderness, heightened sensitivity to touch or temperature, poor sleep, or pain that seems disproportionate to what imaging shows, your treatment plan may need to address the nervous system’s role alongside the joint itself. Strategies might include medications that target nerve sensitization, cognitive behavioral therapy, or graded exercise programs designed to recalibrate pain processing. Identifying this pattern early can save you from cycling through increasingly invasive treatments that target the joint while the real driver is elsewhere in the system.

Bone Marrow Aspirate Concentrate

Bone marrow aspirate concentrate (BMAC) occupies a space between PRP injections and full surgical intervention. The procedure involves drawing bone marrow (usually from the pelvis), concentrating its stem cells and growth factors, and injecting the concentrate into the hip joint. A systematic review of the available clinical evidence, covering five studies and 182 patients, found that BMAC led to reduced pain, improved function, and better quality of life with no adverse events reported across all studies.²⁵

The catch is that the evidence base is still thin. Five studies with a combined 182 patients is a very small foundation for strong conclusions, and the individual study sizes ranged from just 4 to 112 participants. BMAC is also expensive and typically not covered by insurance. It may be worth considering if you’re trying to delay hip replacement and have already tried corticosteroids and PRP without adequate relief, but go in with realistic expectations about how much certainty currently backs the approach.