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Hip injections come up in my office almost every day. Patients want to know if a shot can calm their hip arthritis, how long the relief lasts, and whether an injection now could cause a problem if they need surgery later. Those are exactly the right questions.
I am a board-certified orthopaedic surgeon at the Bone and Joint Institute of Tennessee in Franklin. I perform more than 700 hip and knee replacements every year, and a large share of those patients tried injections first. So I have seen, up close, where injections shine and where they fall short. Here is the honest version of that conversation.
What Are Hip Injections and How Do They Work?
A hip injection is medicine placed directly into or around the hip joint with a thin needle, usually to reduce inflammation and pain. Inflammation is the swelling and irritation inside an arthritic joint, and it is a major driver of hip pain.
The hip is a deep joint, buried under thick muscle. That is why these injections should be done with ultrasound or fluoroscopy (a real-time X-ray). Studies show image-guided injections land inside the joint 90 to 100 percent of the time. Injections done by feel alone can be as low as 72 percent accurate. A shot that misses the joint cannot help the joint.
Most patients are surprised by how quick the visit is. The skin is numbed, the needle is guided into place, the medicine goes in, and you are typically walking out within minutes. Light activity is usually fine the same day.
Which Hip Injections Actually Work?
Cortisone has the strongest track record for hip arthritis, while gel, PRP, and stem cell injections have weaker or mixed evidence in the hip. Here is how I explain each option to my patients.
Cortisone Injections: The Workhorse
A cortisone (corticosteroid) injection is a strong anti-inflammatory medicine, usually mixed with a numbing agent. The numbing medicine wears off within hours; the steroid begins working about 2 to 7 days later.
Research supports cortisone for short-term relief of hip osteoarthritis. It is also the only injection the American Academy of Orthopaedic Surgeons recommends for the arthritic hip. In my practice, it is the shot I reach for first when a patient needs real relief from a painful, inflamed hip.
Hyaluronic Acid (Gel) Injections
Hyaluronic acid is a lubricant that occurs naturally in joint fluid. Gel injections are FDA-approved for the knee, not the hip, so hip use is off-label. Some patients with mild to moderate hip arthritis report months of relief. The research overall has not shown a consistent benefit in the hip.
PRP and Stem Cell Injections
Platelet-rich plasma (PRP) is made by concentrating platelets from your own blood, then injecting them into the joint. Stem cell injections use cells drawn from bone marrow or fat. Both are promising ideas, and I understand why patients ask about them.
Here is what I tell my patients: current evidence does not show that PRP or stem cell injections predictably relieve hip arthritis or regrow cartilage, and insurance rarely covers them. If you are considering one, ask hard questions about cost, evidence, and expectations first.
Diagnostic Numbing Injections
Sometimes the most valuable injection is not a treatment at all; it is a test. If numbing medicine placed inside the hip joint takes the pain away, even briefly, the joint is the source. If it changes nothing, we look elsewhere, such as the spine or the tendons around the hip. That single piece of information can save months of chasing the wrong problem.
How Long Does a Hip Injection Last?
Most cortisone hip injections provide relief for a few weeks to several months. The effect varies widely from patient to patient. One large review found steroid injections reliably reduced hip arthritis pain for about four weeks, with some patients getting much longer relief.
Two things predict shorter relief: more advanced arthritis and a longer history of pain. A hip that is bone-on-bone rarely stays quiet for long, no matter what we inject into it.
That is not a failure. Used wisely, an injection can carry a patient through a wedding, a busy season at work, or the months spent preparing for surgery. It just should not be mistaken for a cure.
Are Hip Injections Safe?
For most patients, hip injections are low risk when performed with sterile technique and image guidance. Serious problems such as joint infection are rare. Common, temporary side effects include soreness at the injection site and a steroid flare, which is a brief increase in pain for a day or two.
Who Should Be Cautious with Hip Injections?
Patients with diabetes can see a short spike in blood sugar for up to a week after a steroid shot. Closer glucose checks are smart during that window. Patients who already have an artificial hip should generally avoid steroid injections in that joint because of infection risk.
Repeated steroid injections may also speed up cartilage wear over time. That is why I space hip injections out and set a sensible limit, rather than injecting on a fixed schedule.
Can Hip Injections Affect Future Hip Replacement Surgery?
Yes, and this is the point too many patients never hear: a steroid hip injection should be given at least 3 months before total hip replacement surgery. Injections given closer to surgery have been linked to a higher risk of infection in the new joint. Steroids quiet the immune response inside the joint. That is great for pain and less great right before an implant goes in.
In my practice, if a patient is likely headed toward surgery within the next three months, I will usually recommend against a steroid injection and talk through other ways to stay comfortable. Timing the injection correctly protects the result that matters most: a healthy, lasting hip replacement.
When Is It Time to Look Beyond Injections?
When injections wear off faster each time, when night pain returns, or when you are planning your life around your hip, it is time to talk about the next step. In one study of patients who received steroid hip injections for arthritis, nearly half went on to total hip replacement within two years. Injections buy time; they do not change where advanced arthritis is heading.
The good news is that the next step is better than it has ever been. I perform anterior approach hip replacement and robotic-assisted joint replacement, techniques designed to spare muscle and speed early recovery. After more than twenty years doing this, my view is simple: injections and surgery are not rivals. They are tools, and the skill is knowing which tool fits which moment.
If you are not ready for surgery, that is fine too. Physical therapy, weight management, activity changes, and anti-inflammatory medication remain the foundation of nonsurgical joint pain treatment, with injections layered on when they make sense.
Hip Pain Help in Franklin, Nashville, and Middle Tennessee
If hip pain is limiting your life, start with an accurate diagnosis. I see patients at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067. My patients come from Franklin, Nashville, Brentwood, Spring Hill, Columbia, and across Middle Tennessee. We will review your X-rays together, talk honestly about whether an injection, therapy, or surgery fits your situation, and build a plan around your goals.
Schedule a consultation with Dr. Calendine online or call (615) 791-2630.
This article is for educational purposes only and does not replace personalized medical advice from your own physician. Every patient is different; always discuss your specific situation, medications, and treatment options with a qualified orthopaedic provider before making medical decisions.
References
- Rampal S, Jaiman A, Tokgoz MA, Arumugam G, Sivananthan S, Jagdeb Singh RS, et al. A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis: To inject or not to inject in hip osteoarthritis? Jt Dis Relat Surg. 2022;33(1):255-262.
- McCabe PS, Maricar N, Parkes MJ, Felson DT, O’Neill TW. The efficacy of intra-articular steroids in hip osteoarthritis: A systematic review. Osteoarthritis Cartilage. 2016;24(9):1509-1517.
- Lai WC, Arshi A, Wang D, Seeger LL, Motamedi K, Levine BD, et al. Efficacy of intraarticular corticosteroid hip injections for osteoarthritis and subsequent surgery. Skeletal Radiol. 2018;47(12):1635-1640.
- Werner BC, Cancienne JM, Browne JA. The timing of total hip arthroplasty after intraarticular hip injection affects postoperative infection risk. J Arthroplasty. 2016;31(4):820-823.
- Hoeber S, Aly AR, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med. 2016;50(7):392-396.
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip Evidence-Based Clinical Practice Guideline. American Academy of Orthopaedic Surgeons; 2017.
