Intra-articular injections are a common non-surgical option for managing the persistent pain associated with hip arthritis, most frequently osteoarthritis. This condition involves the progressive degeneration of the cartilage that cushions the ball-and-socket joint. When conservative treatments like oral anti-inflammatory medications and physical therapy no longer provide adequate relief, injections deliver targeted medication directly into the joint space. These minimally invasive procedures serve both as a therapeutic measure to reduce inflammation and pain, and sometimes as a diagnostic tool to confirm the source of discomfort.
Corticosteroid Injections
Corticosteroid injections, often called cortisone shots, are the most traditional and widely used injection for hip arthritis due to their potent anti-inflammatory effects. The mechanism involves delivering a synthetic corticosteroid, such as triamcinolone, directly into the joint capsule. This medication mimics the anti-inflammatory action of the naturally produced hormone cortisol, reducing swelling and inhibiting destructive enzymes that contribute to the pain cycle.
Relief is typically rapid, often beginning within a few days after the procedure. However, the pain relief is temporary, generally lasting from a few weeks to a few months, depending on the arthritis severity. Because the hip joint is deep, these injections require imaging guidance, such as fluoroscopy (real-time X-ray) or ultrasound, to ensure accurate needle placement.
While generally safe, a common short-term side effect is a temporary increase in pain, known as a “steroid flare,” which resolves within 48 hours. Patients with diabetes should be monitored carefully due to the potential for elevated blood sugar levels. Due to concerns about potential long-term damage to the joint cartilage, medical guidelines limit these injections to three or four times per year.
Hyaluronic Acid Injections
Hyaluronic acid (HA) injections, also known as viscosupplementation, work by restoring the natural lubricating properties of the joint. HA is a substance naturally found in healthy joint fluid, where it acts as a shock absorber and lubricant. In a joint affected by osteoarthritis, the concentration and quality of this natural HA are often diminished.
The injection introduces a synthetic or processed form of HA into the hip joint to improve the viscosity of the synovial fluid, reducing friction and improving mobility. While HA injections are standard for knee osteoarthritis, the evidence supporting their efficacy for hip arthritis is mixed. Some studies suggest that patients with mild to moderate hip osteoarthritis may experience improvement in pain and function for up to six months.
HA injections take longer to show an effect than corticosteroids, with noticeable improvement occurring over several weeks. A single injection can be administered, or sometimes a series of injections is used. A major advantage is that this treatment is not associated with the same long-term joint health concerns as repeated corticosteroid use, with side effects limited to temporary local discomfort or swelling.
Regenerative Therapies
Regenerative therapies, often called “orthobiologics,” leverage the body’s own healing mechanisms to treat arthritis. The two most common forms are Platelet-Rich Plasma (PRP) and cell-based treatments, such as Bone Marrow Aspirate Concentrate (BMAC). These therapies are intended to promote tissue healing and reduce chronic inflammation, rather than just masking pain.
Platelet-Rich Plasma (PRP)
Platelet-Rich Plasma therapy involves drawing a small amount of the patient’s blood, concentrating the platelets, and injecting the resulting plasma into the hip joint. Platelets are rich in growth factors and signaling proteins that stimulate tissue repair and modulate the inflammatory response. PRP is considered for patients with mild to moderate arthritis seeking a longer-lasting effect than traditional injections.
Cell-Based Therapies
Cell-based therapies, often incorrectly referred to as “stem cell” injections, commonly use Bone Marrow Aspirate Concentrate (BMAC). This involves harvesting a small amount of bone marrow, usually from the hip bone, and concentrating the cells before injection. These concentrated cells contain mesenchymal stem cells, which reduce inflammation and potentially differentiate into cells needed for tissue regeneration.
The use of both PRP and cell-based therapies for hip osteoarthritis is still largely considered experimental, and results are highly variable depending on the preparation method and the severity of the condition. These treatments are significantly more expensive than steroids or HA. PRP costs hundreds to over a thousand dollars per injection, and cell-based treatments range from $3,500 to $15,000. Insurance rarely covers these procedures, leaving the patient responsible for the cost.
Duration, Cost, and Determining the Best Injection
There is no single “best” injection for hip arthritis; the optimal choice depends on the patient’s goals, the severity of their condition, and financial considerations. The three injection categories offer distinct trade-offs in speed of relief, longevity of effect, and cost.
Corticosteroid injections provide the fastest pain relief, often within days, making them ideal for acute flares or diagnostic purposes. However, their effect is the shortest, lasting weeks to a few months. Hyaluronic acid injections act more slowly, taking several weeks, but may offer a sustained benefit for up to six months, particularly in earlier-stage arthritis. Both treatments are typically covered by most insurance plans, making them the most accessible options.
Regenerative therapies (PRP and BMAC) offer the potential for the longest duration of effect, sometimes exceeding six months, but the results are unpredictable and may take longer to appear. These options carry the highest out-of-pocket cost and are not covered by insurance, as they are not yet considered standard medical care. A patient seeking rapid, reliable, and covered short-term relief will likely choose a corticosteroid. Conversely, a patient prioritizing potential long-term benefit and willing to accept a higher, uninsured cost may consider a regenerative option.