Therapeutic Injections for Osteoarthritis of the Hip
If pain caused by osteoarthritis of the hip keeps you from everyday activities even after you’ve tried other medical treatments, doctors may recommend an injection of medication directly into the arthritic joint. An injection of corticosteroids may reduce inflammation and ease pain.
Other, more experimental injections—such as hyaluronic acid, platelet-rich plasma, or stem cells—may relieve pain and encourage healing in damaged soft tissues. Your doctor can discuss whether you are a candidate for these injections, which are not approved by the U.S. Food and Drug Administration for treating osteoarthritis of the hip. Some people find that therapeutic injections provide long-term pain relief and help them remain active, but they may not be appropriate for everyone.
Our doctors administer therapeutic injections using X-ray or ultrasound guidance, which provides images of the hip joint on a computer monitor. This technology ensures that doctors inject medication precisely into the joint space.
Corticosteroids are anti-inflammatory medications that may provide pain relief when injected directly into the hip joint. Corticosteroids reduce inflammation, which is part of the body’s immune system response and causes pain and swelling.
Typically, doctors inject a small amount of anesthetic in addition to corticosteroids to provide short-lasting but immediate pain relief. This anesthetic wears off a few hours after the injection, at which time hip pain may return. The corticosteroid solution begins to work two to three days later. For some people, a corticosteroid injection provides pain relief that lasts for many months, and in others, the injection doesn’t work at all. Doctors recommend no more than a total of two or three corticosteroid injections in the hip joint.
Hyaluronic Acid Injection
The healthy hip joint contains a small amount of a gel-like substance called synovial fluid. Synovial fluid contains a unique component called hyaluronic acid, which cushions and lubricates the joint during activity. As people age, the hyaluronic acid can break down, causing the synovial fluid to become thinner and less effective as a lubricator and shock absorber.
To address the changes in the synovial fluid of hips affected by osteoarthritis, doctors at NYU Langone inject into the joint space a hyaluronic acid product. The injection is designed to make the fluid more substantial and to improve the joint’s gliding motion. This improved joint function may provide pain relief that lasts months or longer.
These injections do not provide relief to everyone, as is the case for all osteoarthritis treatments. Researchers at NYU Langone continue to investigate how to identify whether a person is likely to benefit.
Your doctor may recommend a single injection or a series of three injections administered once per week. NYU Langone doctors generally prescribe hyaluronic injections a maximum of twice per year.
What to Expect After Corticosteroid or Hyaluronic Acid Injections
Most people can return home or to work immediately after the injection takes place. The site of the injection may be swollen or tender for one or two days. Your doctor may recommend applying ice two or three times a day or taking an over-the-counter medication to relieve pain and reduce swelling.
It may take several weeks to see improvement after a hyaluronic acid injection. Our doctors recommend restricting high-impact activity, such as running, until symptoms improve.
A person may feel the pain relief effects of corticosteroid injections more quickly than those of hyaluronic acid, but the results may not last as long. But each person may respond differently to either of these injections.
Acupuncture is a therapeutic technique in which doctors insert very thin needles into various points on the surface of the body. By targeting specific points along “meridians” that correspond to the nerve pathways affected by osteoarthritis of the hip, acupuncture may stimulate healing by increasing blood flow and can improve joint function. Acupuncture may also prompt the body to release endorphins, which are natural pain relievers.
Our licensed acupuncturists administer this therapy in a relaxed setting at NYU Langone. Acupuncture needles are left in place for 20 to 40 minutes. For optimal results, doctors may recommend several acupuncture sessions.
Platelet-Rich Plasma Injection
Doctors may inject a natural substance called platelet-rich plasma (PRP) into the hip to help injured tissue heal more quickly. Platelet-rich plasma is composed of blood cells called platelets that are taken from your own blood. Platelets help tissues heal after an injury by releasing substances called growth factors that stimulate healing.
In this procedure, a doctor takes a small amount of your blood from a vein in your arm and uses a machine called a centrifuge to separate the platelets and growth factors from other blood components. This process takes about 15 minutes.
A doctor then injects this platelet-rich liquid, called plasma, directly into the hip joint. Our doctors use ultrasound guidance to ensure precision. People often experience pain relief and improved function within two to six weeks.
Because this is an experimental treatment, PRP injections may not be covered by your insurance company.
Stem Cell Injection
Doctors at NYU Langone also offer stem cell injections, an experimental new technique. Stem cells are unique in that they can develop into any type of cell—for example, cells that help repair damaged tissue. When injected into an arthritic hip, stem cells may encourage the damaged cartilage to regrow and heal. Injections of stem cells also reduce inflammation.
The exact way stems cells work is still being researched, but some people find that an injection of stem cells relieves pain and swelling and may help speed recovery.
Our doctors obtain these stem cells from your body, typically from bone marrow in your pelvic bone, using a syringe. The area is thoroughly numbed before the stem cells are extracted, but the procedure may cause mild discomfort. After the stem cells are separated from blood and other substances in the bone marrow, they are injected directly into the hip.
Stem cell therapy does not produce results right away. Over time, their regenerative effect may help damaged tissues to heal. Most people experience improved function and relief from pain after two to six weeks. Because this is an experimental treatment, stem cell injections may not be covered by your insurance company.
What to Expect After PRP or Stem Cell Injections
Doctors recommend avoiding anti-inflammatory drugs such as ibuprofen for four to six weeks after a therapeutic injection with stem cells or PRP while the injury heals. This is because injections of biologic material stimulate the body’s inflammatory response, an important part of healing. If the injection site is sore or swollen in the days after treatment, doctors recommend taking over-the-counter acetaminophen and applying an ice pack for 15 minutes at a time, three times a day.
You should also avoid strenuous activities involving the hip for four weeks after an injection to give the injured tissue time to heal. Your doctor may provide crutches to help you move around for a few days without putting weight on the joint.
Your doctor schedules a follow-up appointment after three or four weeks to evaluate the healing process. He or she may recommend an additional PRP or stem cell injection depending on the extent of joint damage.