Below, Betsy, a hip dysplasia patient who continued to experience hip pain after her total hip replacement, describes her personal experience getting a steroid injection into her iliopsoas bursa (the lubricating pad around her hip flexor tendon). Here is a little more information about cortisone injections for hip pain.
People with hip pain may get injections for two main reasons: diagnosis and treatment. During a diagnostic injection your doctor or other healthcare professional injects numbing medicine into the area that they think is causing pain. If this helps reduce your pain, it is considered a “positive response.” The numbing usually only lasts for a few hours.
Sometimes your doctor will do a steroid injection like the one that Betsy had. This type of injection includes a steroid medication that to reduce inflammation and reduce your pain. Sometimes a numbing medicine is also given with the steroid to help with diagnosis and to also give some temporary pain relief. This wears off within a few hours, but the steroid should stary working within a few days or up to a week. Steroid injections may last up to a few weeks or even a few months.
Betsy’s injection is an extraarticular injection (extra = outside, articular = joint) since the medicine was placed in the bursa, which is a structure outside the hip joint that surrounds the hip flexor tendon. Another common bursa that is injected outside the joint is the trochanteric bursa which is on the outside of the thigh. Extraarticular injections are also commonly used for muscle tendons around the hip.
Injections may also be intraarticular injections (intra = in, articular = joint). These injections go into the actual hip joint to treat pain in the hip from arthritis, labral tears, or other structures inside the joint.
Diagnostic and steroid injections for the hip are usually done using ultrasound or may be done under a special x-ray called fluoroscopy.
If your doctor recommends a hip injection, here are a few questions you can ask them:
- What hip structure will be injected?
- What is the goal of the injection? Is it to diagnose my pain or treat my pain or both?
- Who will be doing this injection? How will they do the injection?
- What are the possible risks and benefits of this injection?
- When should I follow up with you to discuss the results of the injection?
Different patients have different experiences to hip injections, so your personal experience may be different than Betsy’s. If you have additional questions or feel anxious about getting a hip injection, talk to your doctor so that they can help you feel comfortable and prepared for your injection.
Cortisone Injection for Hip Pain: a Patient’s Experience
by Betsy Miller
Six years after my left hip replacement, I was living in a different city and saw a new orthopedic doctor (Dr. F) about my chronic hip pain. This was in the front of my left hip, especially when I lifted my leg. This problem started right after that hip was replaced. It hurt to do simple things like getting out of bed, getting dressed, walking up stairs, and getting in and out of a car. I went through many rounds of physical therapy over the years, which helped to some degree, but didn’t solve this issue.
How hip dysplasia affected my hip replacement
Even though Dr. D, the orthopedic doctor who did my left hip replacement, deepened my hip socket during the surgery, it’s still shallower than normal. Now my left hip is very stable, but with some movements the implant is in direct contact with my soft tissue. (I didn’t find out until recently that is what was happening!)
My hip did get a lot better after the hip replacement—it’s just too bad a new problem developed. There isn’t a good way around this problem because of how shallow my hip socket is on that side. Dr. D did what is possible with the amount of bone that I have. That means a revision surgery can’t make it any better. My left hip has always been more severe than the other side. I still have my original right hip.
What about a cortisone shot?
Dr. F suggested trying a cortisone shot in my left hip. Cortisone is a steroid that is used to reduce inflammation and the pain associated with it. This shot would include both cortisone and lidocaine for additional pain relief.
He explained that the shot might or might not help me. We wouldn’t know until we tried. If it did work, it could give me a few months of pain relief. When a steroid shot works, the first shot typically is the most effective, and subsequent shots work less well. Getting the shot would also give us data: if it worked, that would confirm the diagnosis that my pain was coming from the soft tissue in that area.
Next, I had a blood test to rule out any potential infection and a hip x-ray to make sure my hip implant was okay. Everything was fine, so Dr. F referred me to a physician assistant (PA) named Matt. At this orthopedic office, Matt gives all the injections that are guided by ultrasound since that’s a specialized skill.
Deciding on the shot
I’d never tried a cortisone shot in my hip before. I was worried the needle would need to go into my joint. I wasn’t sure how that would work after a hip replacement when I had an implant. This procedure sounded like it would hurt, especially since that area in the front of my hip had been painful and tender for six years. I thought it might be hard to stay still and not flinch if the shot did indeed hurt a lot. (If I sound a little paranoid, that’s because previously I had a different kind of steroid shots in my ear after a sudden hearing loss—they were painful, and it was hard to stay still.)
After talking to Matt on the phone, the hip shot sounded less terrible than the ear shots. (Spoiler alert, it was significantly less terrible.) Since my husband and I were going on a trip in a few months, this seemed like a good time to give it a try—to schedule the cortisone shot about a month before our vacation. I decided to go for it.
What happened when I got my shot
When I came in for my appointment, I was relieved to find out that the injection would go into the top of my thigh in the front, not into my joint. Matt used ultrasound to make sure that he knew exactly where to position the needle. At the time, I thought he was giving me an injection in my psoas tendon, but later when I read the notes after my appointment, I discovered the shot was in my psoas bursa. A bursa is a kind of soft tissue that is a small fluid filled sac. There are many bursae throughout the body: they act as cushions between bones and other soft tissues like tendons.
I found the shot to be more painful than the estimate I was given of 1 or 2 on a scale of 1 to 10. In my case, it was about 5 out of 10, but the injection didn’t take long. Matt had to remind me to breathe. I didn’t even realize I was holding my breath!
How things have been since my shot
By that evening, I noticed a real difference in my left hip. I remember sitting on the couch watching TV and realizing my right hip was aching (it’s pretty common for both of my hips to ache), but the left hip didn’t hurt at all! It’s a couple of weeks later as I’m writing this. I still have some pain in my left hip at times, but I can lift my leg higher without pain, which means getting dressed no longer hurts! And now I know what bursitis is—it’s when a bursa is painful and inflamed.
I’m glad I got the shot. I’m looking forward to having less pain and more options for fun activities on vacation.
References:
Hip joint injection: MedlinePlus Medical Encyclopedia
Cortisone Shots (Steroid Injections): Benefits & Side Effects