There are two major components to treating hip osteoarthritis. The first is taking away the inflammation from the joint to alleviate the pain; and the other is to make sure that we address the biomechanics to take the pressure off the hip so that the inflammation doesn’t return.
When symptoms are persistent despite physical therapy, or if the symptoms are getting in the way of participating with physical therapy, there are a couple of different injection alternatives that one can employ. We can either be injecting steroids into the hip or hyaluronic acids into the hip.
Steroid injections in the hip, first of all, they should be done under fluoroscopic guidance because it’s a relatively deep structure so the best way to get into the hip is to use an X-Ray to guide the needle in. And when you put steroid into the hip, you’re not again fixing the hip osteoarthritis, you’re also not masking pain, you’re reducing the inflammation, and ideally you’re resetting the inflammatory clock back down to zero which should allow someone to take more advantage of the physical therapy, to stretch, to strengthen, to really tweak the biomechanics so that ideally, the inflammation doesn’t recur.
The other kind of injection that one can do in the hip is hyaluronic acid. This is more commonly done in the knee, but it can be done in the hip as well. Hyaluronic acid is basically putting joint fluid back into the joint is the best way to think about it. You’re basically putting in — through a series of injections – either one three, four, or five injections depending on the brand that you use. You’re putting this viscous substance in to lubricate the joint and to wash out the inflammatory proteins. Again with the hyaluronic acid injections, you’re not fixing the hip osteoarthritis, the injections will wear off typically within about — typically after about six months. So again, what we’re using the injections for is more as a window of opportunity during which we can stretch and strengthen and address the whole kinetic chain, the biomechanics so that at the end of those six months, we’re not sitting back there having to do it again.
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