Corticosteroid injections, commonly known as cortisone shots, are used to reduce localized inflammation and relieve pain in the hip joint. These shots typically treat conditions like osteoarthritis, bursitis, or tendinitis, where excess inflammation causes discomfort. The injection delivers a powerful anti-inflammatory medication directly to the affected area, often combined with a local anesthetic for immediate, temporary relief. When this treatment fails to provide lasting comfort, it signals a need to re-evaluate the underlying cause of the patient’s pain and investigate alternative treatment pathways.
Why the Injection May Not Provide Relief
The primary reason a cortisone injection may not succeed is an incorrect identification of the actual pain source. The hip is a complex area, and pain felt there can originate from various structures, including the lower back or nerves, a phenomenon known as referred pain. For instance, what is clinically diagnosed as bursitis on the outer hip may actually be pain stemming from a tendon issue, or gluteal tendinopathy, which is less responsive to corticosteroid treatment. If the targeted inflammation is merely a symptom of a larger mechanical or neurological problem, the shot will not address the root cause.
A second factor in treatment failure relates to the precision of the injection procedure itself. Even when imaging guidance, such as ultrasound or fluoroscopy, is used, the medication may not fully reach the exact location of the inflammation. If the steroid does not bathe the inflamed tissue, its anti-inflammatory effects cannot be delivered, resulting in minimal or no relief. Furthermore, the severity of the underlying condition may simply exceed the therapeutic capacity of the dose provided.
The extent of the underlying disease also plays a substantial role. In cases of advanced hip osteoarthritis, the pain is often caused by mechanical damage, specifically bone-on-bone friction, rather than inflammation alone. When the cartilage is extensively worn down, reducing inflammation offers limited benefit, as the structural damage remains the dominant source of pain.
Confirming the Lack of Effectiveness
Assessing the success or failure of a cortisone injection requires a specific period of observation. While the anesthetic component provides immediate numbness, the corticosteroid itself typically takes a few days to begin working. Most patients should expect to notice the anti-inflammatory effect peaking within three to seven days of the procedure. If no meaningful improvement in pain or function occurs within two weeks, the injection is likely considered a failure.
Some patients experience a temporary increase in pain, known as a “cortisone flare,” which usually subsides within 48 hours. However, if the initial temporary relief from the local anesthetic quickly disappears and is followed by a rapid return to pre-injection pain levels, this is also deemed an unsuccessful outcome. A follow-up evaluation with the treating physician is necessary to formally confirm non-response, which may involve a physical re-examination and potentially further diagnostic imaging to reconsider the initial diagnosis. The initial injection itself sometimes serves a diagnostic function; if the pain is not relieved, it suggests the targeted area was not the true source of the discomfort.
Next Steps: Non-Surgical Treatment Pathways
Once a hip cortisone shot has been confirmed as ineffective, the next course of action involves pursuing other conservative or minimally invasive therapies before considering surgery. Physical therapy is frequently the first alternative, focusing on addressing the mechanical issues that may be driving the pain. This therapy includes specific exercises to strengthen the hip’s surrounding musculature, such as the gluteal muscles and core, which helps to stabilize the joint and improve faulty movement patterns. Enhancing joint stability through targeted muscle work can reduce the mechanical stress that causes chronic irritation and inflammation.
In addition to physical therapy, a physician may optimize the patient’s oral medication regimen. This could involve adjusting the dosage or type of nonsteroidal anti-inflammatory drugs (NSAIDs) or introducing neuropathic pain medications if nerve involvement is suspected. Lifestyle modifications, such as weight management and switching to low-impact exercises, are also frequently recommended to decrease the load and strain on the hip joint.
Alternative injectable therapies represent the next level of minimally invasive intervention:
- Hyaluronic Acid (HA) injections, also called viscosupplementation, aim to supplement the natural lubricating fluid in the joint, which can be depleted in osteoarthritis.
- Platelet-Rich Plasma (PRP) injections utilize the patient’s own concentrated growth factors.
- PRP is believed to promote tissue repair and reduce pain by stimulating the body’s natural healing mechanisms.
- This regenerative approach targets underlying tissue damage rather than just suppressing inflammation.
Advanced Treatment: Evaluating Surgical Options
When all non-surgical treatments have failed to provide lasting relief, the conversation shifts to surgical interventions. Surgery is typically reserved for individuals whose pain significantly affects their quality of life and mobility. The choice of procedure depends entirely on the underlying pathology that non-surgical methods could not address.
One option is a hip arthroscopy, a minimally invasive technique where small instruments and a camera are inserted into the joint. This procedure is often used to address specific structural problems like labral tears, where the ring of cartilage around the socket is damaged, or femoroacetabular impingement (FAI), where bone spurs cause abnormal friction. If the pain is due to severe, end-stage degenerative joint disease, such as advanced osteoarthritis, the definitive long-term solution is often a total hip arthroplasty, or hip replacement. This procedure involves surgically removing the damaged cartilage and bone and replacing them with prosthetic implants to restore joint function and eliminate pain caused by bone-on-bone contact.