PROCEDURE: Hip Injection
NOTE: THESE PROCEDURES OR INJECTIONS SHOULD ONLY BE ADMINISTERED BY AN MD OR DO TRAINED IN INTERVENTIONAL PAIN MEDICINE
Anatomy of the hip joint
The hip joint is a ball and socket joint located where the thigh bone meets the pelvis. The top of the thigh bone (the femur) is a round ball, which fits into the socket formed by a cavity in the pelvic bone. The ball is held in the socket by a grouping of ligaments that form a capsule around the joint. This capsule of ligaments contains synovial fluid which acts as a lubricant. There is cartilage between the two bones, which allows them to move against each other without causing friction.
Hip joint injection procedure Fluoroscopy (live x-ray) is commonly used in hip joint injections for guidance in properly targeting and placing the needle, and for avoiding nerve or other injury.
On the day of the injection, patients are advised to avoid driving and doing any strenuous activities.
The hip joint injection procedure includes the following steps:
- The patient lies face down on an x-ray table and the skin over the hip is well cleaned.
- The physician numbs a small area of skin with an anesthetic (a numbing medicine). The patient may feel a sting that will last for a few seconds.
- The physician uses x-ray guidance (fluoroscopy) to direct a very small needle into the joint. Several drops of contrast dye are then injected to confirm that the medicine only reaches the joint.
- A small mixture of anesthetic and anti-inflammatory cortisone is then slowly injected into the joint.
The injection itself only takes a few minutes. Patients may or may not obtain pain relief in the first few hours after the injection, depending upon whether or not the joint that was injected is the main source of the patient’s pain. On occasion, the patient may feel numb or experience a slightly weak or odd feeling in the leg for a few hours after the injection.
The patient will discuss with the doctor any immediate relief of pain, and will then record the levels of pain relief during the next week. A pain diary is helpful to clearly inform the treating physician of the injection results and in planning future tests and/or pain management treatment, as needed.
Pain relief after a hip joint injection Patients may notice a slight increase in pain lasting for several days as the numbing medicine wears off and the cortisone is just starting to take effect. If the area is uncomfortable in the first two to three days after the injection, applying ice or a cold pack to the general area of the injection site will typically provide pain relief and appear more beneficial than applying heat.
If the hip joint that was treated is the source of the pain, the patient may begin to notice pain relief starting two to five days after the injection. If no improvement occurs within ten days after the injection, then the patient is unlikely to gain any pain relief from the injection and further diagnostic tests may be needed to accurately diagnose the patient’s pain.
Patients may continue to take their regular medicines after the procedure, with the exception of limiting pain medicine within the first four to six hours after the injection, so that the diagnostic information obtained is accurate. Patients may be referred for physical therapy or manual therapy after the injection while the numbing medicine is effective and/or over the next several weeks while the cortisone is working.
On the day after the procedure, patients may return to their regular activities. When the pain has improved, it is advisable to start regular exercise and activities in moderation. Even if the pain relief is significant, it is still important to increase activities gradually over one to two weeks to avoid recurrence of pain.
What is an Intra-Articular Joint Injection? Injections into joints (ie. hip, shoulder, wrist) are intra-articular injections. If you have a swollen or painful joint your doctor may inject a steroid medication into the joint. Sometimes your doctor may inject a local anesthetic (numbing medicine) along with the steroid.
Why Should I have an intra-articular steroid injection? The steroid injection is given to decrease pain and swelling in the joint.
How long does it take the steroid injection to work and how long will it last? It varies between people; improvement usually starts within 1 to 2 days. If helpful, the injection usually lasts from a few weeks to several months.
What is injected into my joint? The steroid medications are related to cortisone, which is produced by the body itself.
The purpose of the injection is to calm down the excessive inflammatory process that may be going on because of injury, excess use, or similar problems. Cortisone injections can also be used for diagnosing some conditions, such as carpal tunnel syndrome, wrist ligament tears, etc. The form of cortisone that I use is called triamcinolone acetonide. It has the longest duration of action and the greatest potency of the cortisones. The most likely side effect is decrease of skin pigmentation in a region about the size of a dime or a quarter. This is not permanent, but may last up to a year.
Are there any side effects? Side effects are very unlikely. Occasionally, the joint is worse for the first 24 hours after the injection. After that the joint normally settles. If the joint becomes more painful after this, please call 718 687 2010 as this could be a sign of infection (a very rare complication). A large number of injections into the same joint may cause damage to the joint.
How do I do it painlessly? I put fast acting numbing medicine in the shot. What is it? Lidocaine (a numbing medicine) that I have specially buffered (made the pH the same as the body’s) to take all of the sting out of it and to speed up how fast it works. The Lidocaine usually is effective in one to two seconds. Amazing, right? This way, you do not feel the long acting numbing medicine or the steroid medicine, which is actually the medicine that does the job.
How many injections can I have? There is no firm limit to the number of injections. However, the effect tends to decrease with repeated injections. There could also be problems from a large number of injections into the same joint.
How often can I have an injection? There is no firm rule about this, but your doctor will want to avoid repeating the injection more often than is necessary.
Do I need to do anything myself after the injection? You should rest the joint after the injection for the first 24-48 hours, especially after the knee or ankle has been injected.