What You Need To Know About Injections For Treating Hip Pain
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This article is part of the the Ultimate Guide to Hip Pain Relief.
There are a variety of treatments that a patient can explore and be recommended to for their hip pain. Throughout your treatment you may find that a hip injection is recommended for your pain. Injections are useful adjuvants to help with symptoms such as hip osteoarthritis.
IBJI recently chatted with Dr. Marc Angerame, board certified orthopedic surgeon with fellowship training in adult reconstruction and hip and knee replacement. Dr. Angerame talks about injections for treating hip pain and how they work. His responsesbelowhave been edited and condensed for space.
How Do I Prepare For Viscosupplementation Treatment For Arthritis
Talk to your healthcare provider about all your medical conditions. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines, like aspirin. Take all of your medicines as normal, unless your healthcare provider tells you otherwise.
The day of your procedure, you can eat and drink as you normally would. Tell your healthcare provider about any new symptoms, like fever. You may want to wear loose clothing so that you can easily expose your joint. Your healthcare provider might give you other instructions about what to do before your procedure.
How Do Hyaluronic Acid Knee And Hip Injections For Pain Work
Our specialist orthopaedic surgeons can inject hyaluronic acid into your hip or knee joint, in the part which contains synovial fluid.
The non-surgical treatment works by restoring the normal balance between the breakdown and production of hyaluronic acid. Injecting hyaluronic acid into the joint is also known as viscosupplementation.
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The Typical First Recommendation: Intra
People will contact us with a medical history that included or will include cortisone injection into the hip as their main component of treatment, that is for now. For now meaning, until such time as a hip replacement can be confidently recommended. When is that? Usually when an MRI says bone on bone. Here is a story or two we may hear:
I am very concerned with cortisone injections.
I am not quite bone on bone yet. After a meeting with my surgical team and a second opinion with another orthopedists office, it was clear that I was being steered towards an eventual hip replacement. Because my hips were in different stages of degeneration they would be done separately at times in the future.
With good physical therapy and judicious use of cortisone injections, I should be able to put off the hip replacements for a couple of years. I am not comfortable with this. I am very active, I lead a sports-filled, physical activity lifestyle. I bike, I hike, I have a home gym. I eat healthily and take a lot of supplements. I am very concerned with cortisone injections. Unfortunately, I was told, there is no other way. There must be another way.
My MRI is bad I am on the fast track to hip replacement
I have a new labral tear, I have a new cyst from the labral tear. I have rapidly developing hip osteoarthritis or as my doctor says, I am on the fast-track to hip replacement. I have had cortisone injections and I am wondering if this is causing my accelerated hip degeneration?
Knee Gel Injections Side Effects
Knee gel injections are a type of knee surgery that can be used to treat a number of different conditions. The most common condition that knee gel injections are used to treat is osteoarthritis, but they can also be used to treat other conditions such as meniscus tears, patellofemoral pain syndrome, and tendonitis. The most common side effect of knee gel injections is pain at the injection site. This pain is usually temporary and should go away within a few days. Other potential side effects include infection, bleeding, and bruising. These side effects are rare and most people who have knee gel injections experience no complications.
osteoarthritis can be treated with a gel-one injection. Gel-One is injected directly into the knee joint in a gel form. Please observe your doctors instructions carefully as you dose. Because the medication is given in a medical setting by a healthcare professional, an overdose is unlikely. Because of its composition, gel-one may cause serious side effects. Gel-One may cause nausea, pain, puffiness, stiffness, bruising, or where the injection was administered. If you have severe pain or swelling after the injection, you should consult a doctor as soon as possible. You should bring all of your current medications and any medications you are currently using to the doctors office.
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Before Taking This Medicine
You should not receive Gel-One if you are allergic to it, or if you have an infection in your knee or in the skin around your knee.
Gel-One is not approved for use by anyone younger than 21 years old.
Tell your doctor if you have ever had:
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blood clots or circulation problems in your legs or
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an allergy to birds, feathers, or egg products.
It is not known whether Gel-One will harm an unborn baby. Tell your doctor if you are pregnant.
It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.
Lets Look At Some Of The Concerns Patients Have About These Injections
Many patients want to know if the injections work, how long they last, and how their daily activities and work may be affected.
I like to tell my patients corticosteroids are like hydrocortisone you put on a rash. The first couple days you dont notice much difference but after a couple days the inflammation and itching decrease.
They work the same in the joint.
The medicine decreases the inflammation of the synovium around the joint, and in a couple days it starts to decrease the pain, swelling and inflammation.
Patients can usually resume their normal activities in a day or two with minimal if any restrictions.
Cortisone shots are inexpensive and can provide long lasting relief. Unfortunately, It is difficult to predict how long the injection will last. On the plus side, scientific studies show benefits to cortisone injections and significant improvement even if for a short duration when compared to placeboes.
Concerning how long the injections last, I like to say is if you have mild arthritis, I expect the shot to last 1-3 months or longersometimes up to a year. If you have severe arthritis, it may only last a week or two or even less, but sometimes it can last a longer.
I wish I could say its an exact science, but its not. This is the part where we insert Individual results may vary.
After injections stop working, its time to consider a joint replacement. If youre not sure if youre ready, check out this post by Dr. Barba, one of my colleagues.
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What To Do For Arthritis In The Hip
Overall, treatment of hip arthritis should start with simple steps and then progress to more invasive steps leading up to surgery. Not all these steps will be appropriate for every person. However, you should explore these safer options as many are effective.
- Weight Loss: Probably the most necessary treatment but also under-rated. If you lose weight, you have less load on the hip joint. Also, reducing fat mass decreases inflammation in the joint.
- Activity modification: In some cases, reducing or stopping activities such as football or running can help manage pain.
- Exercise: We know that building the strength of the muscles around the hip and pelvis will reduce the load on the diseased hip joint. Tai Chi and Yoga are thought to be very effective for hip arthritis.
- Improve diet: A healthy diet is conducive to weight loss, but a healthy diet rich in antioxidants will lower inflammation in the body and the hip joint.
The Role Of Hip Injury Injections In Your Treatment
Painful hip injuries are fairly common, especially among older Americans. Inflammation and pain are usually the first symptoms. A more serious injury such as hip tendinitis, hip bursitis or a hip labral tear may require additional treatment. But if a hip joint injection eases your pain, it has a place in your treatment plan.
A cortisone injection in your hip that deadens your pain and works to resolve the swelling cant be the only cure. Most hip injury specialists in NYC recommend using your pain-free time to start or continue physical therapy sessions. Guided stretching exercises increase your hip joint mobility while simultaneously strengthening your back and butt muscles. Stretching exercises are also an effective way to prevent your hip pain from returning.
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Gel Injections: A Pain Relief Option
According to the texts, it is generally recommended that patients suffering from more dull, achy pain, as well as those suffering from acute swelling, use gel injections. Pain, swelling, redness, warmth, or bleeding at the injection site can all be side effects of the injection. The injections can be given for up to six months and last about 8-12 weeks.
What Is Viscosupplementation Treatment For Arthritis
During viscosupplementation treatment for arthritis, your healthcare provider injects hyaluronic acid into your joint. This thick fluid may help reduce pain and swelling in your arthritic joint .
The bones that make up your joints usually have a cap of cartilage on their ends. This cartilage helps make sure that your bones move smoothly against each other. This cartilage has a fluid coating that contains hyaluronic acid. This works like a lubricant and shock absorber in your joint.
In osteoarthritis , this cartilage cap breaks down. When this happens, the bones of your joint scrape together abnormally. People with osteoarthritis generally have less hyaluronic acid in their joints than they should. All of this causes symptoms like pain, stiffness, and swelling. The idea behind viscosupplementation is that replacing this hyaluronic acid may help reduce symptoms.
Your healthcare provider may first inject a numbing medicine into the space around your knee joint and possibly drain any fluid that is causing the joint to swell. Then, your healthcare provider will inject hyaluronic acid into the space inside your joint. You shouldnt expect this to reduce your pain right away. After the full course of treatment, though, you may notice some pain relief.
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What Is The Best Gel Injection For Knees
There is no definitive answer to this question as different people will have different opinions. Some people may find that a certain type of gel injection works better for their knees than others, so it is important to speak to a doctor or other medical professional to get advice on which injection would be best for you.
Hyaluronic acid injections have a much longer effect, lasting between 6 and 12 months. In general, a doctor injects hyaluronic acid into the knee joint as part of their treatment. Dermal reactions, bruising, and pain may be experienced at the injection site after hyaluronic acid injections. Using steroids and hyaluronic acid injections for knee osteoarthritis pain has numerous benefits. Filling a gap between injections and using steroids and hyaluronic acid to treat pain can help joints function more efficiently. Furthermore, steroids and hyaluronic acid injections may be more comfortable than corticosteroid injections and have fewer side effects.
What Are The Risks For Viscosupplementation Treatment For Arthritis
Most people dont have any problems from viscosupplementation, but a small percentage of people do have problems.
The most common problem you might encounter is a flare-up of your arthritis just after your injection. This might cause additional pain and swelling in the short term. Healthcare providers are still learning about the best techniques to help reduce the chances of this complication.
Less common risks include:
- Allergic reaction
- Pain at the injection site
There is also a chance that the treatment will not effectively help your symptoms. Talk to your healthcare provider about all your concerns. Your own risks may vary according to your medical conditions and where and how often you get injections.
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Eleven Studies Compare Prp To Hyaluronic Acid Viscosupplementation
In this article, we will limit the discussion of PRP to a direct comparison to viscosupplementation.
- PRP treatment re-introduces your own concentrated blood platelets into your hip
- Your blood platelets contain growth and healing factors. When concentrated through simple centrifuging, your blood plasma becomes rich in healing factors, thus the name Platelet RICH plasma. Platelets play a central role in blood clotting and wound/injury healing.
What Are The Expected Results
As a proven alternative to surgery, hip joint injections successfully reduce pain for patients. Following the procedure, however, you may have soreness for one to two days. Its recommended that you take it easy the day of the procedure, but return to your usual activities the following day. You can expect immediate relief minutes after the procedure and prolonged relief from the corticosteroid medicine.
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We Have Found Prp To Be Very Effective As Part Of A Comprehensive Multi
PRP treatments for hip pain will not help everyone. But because of the great variation in treatments researchers suggest that it is difficult to tell who the treatment can help and who the treatment will not help.
- Single PRP treatment is not how we see PRP treatments. We see PRP treatments in conjunction with Prolotherapy treatments. In combination, we see these treatments as a means to not only delay the need for a hip replacement but to prevent the need for it by repairing and regenerating tissue in the hip. We see this as the best chance for success.
In our experience, when somebody has degenerative hip disease and the cartilage is wearing away and being lost, you simply cannot repair the cartilage without addressing what is causing the cartilage damage. This is the joint erosion or irreversible joint damage you are hearing so much about. It manifests itself as instability in your hip, the feeling that your hip is giving way or is loose and wobbly.
- It is important that anyone contemplating treatment with platelet-rich plasma therapy should address the instability issue by adding comprehensive Prolotherapy treatments to the PRP treatments. Please see our article The evidence that alternatives to hip replacement can work for you. This includes a more detailed discussion of the use of PRP in combination with hip osteoarthritis.
There are more articles on our website surrounding the avoidance of hip replacement.
Platelet Rich Plasma Injections
Platelet Rich Plasma is relatively new to orthopedics but has been used during surgery for cell regeneration for the last 20+ years. PRP is derived from your immune systems platelets which are found in blood. The platelets are then concentrated and can be injected into the troubled joint area.
PRP injection therapy is said to stimulate healing by producing more collagen. The formation of collagen occurs naturally in skin, bones and tissue. Building collagen in a troubled joint means adding support and even correcting underlying issues caused by arthritis, dysplasia and diseased bone and cartilage. This can reduce pain and improve function.
Timeline: Lasts 3-4 months and can be repeated 1-2 times a year. Cost: Not covered by insurance. $500+.
Pros
- PRP injections are safe with few risks or side effects since the injection substance is naturally occurring in your body.
- Some studies show that PRP is most effective in combating joint paineven more so than cortisone or viscosupplementation. AAOS published a study in April 2017 where a controlled patient group that had PRP therapy showed a 90 percent decrease in pain from baseline. Patients in the steroid group showed an 8 percent increase in pain from baseline.
Cons
PRP injections are offered by private clinics across the USA. Since they are not regulated, prices vary. Single treatments range from $500 to $1250+ depending on location and clinic.
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Remarkable In Their Observations Are Recent Studies That Look At Hip Pain After Replacement Surgery Since The Bone
Doctors who see patients with hip pain significant enough for a hip replacement recommendation tend to focus mainly on the bone-on-bone situation.
Remarkable in their observations are recent studies that look at hip pain after replacement surgery. Since the bone-on-bone was alleviated by replacement what could be causing the patients continued pain?
Doctors at Washington University in St. Louis School of Medicine suggest that it must be the hip ligaments and tendons. They write: surgical management for hip disorders should preserve the soft tissue constraints in the hip when possible to maintain normal hip biomechanics.
This has led to the popularity of tissue-preserving minimally invasive surgical approaches to the hip that may allow early short-term recovery, achieve hip joint stability, minimize muscle strength loss from surgery, spare the peri-articular soft tissues, and allow unrestricted motion in the long term, as described in research by surgeons at San Luca Hospital in Italy.
Again, the realization that limited range of motion and/or pain with motion may not be solely caused by a bone-on-bone situation has led doctors to further understand the relationship of the hip ligaments to pain and limited range of motion and in our research, in the Journal of Prolotherapy we showed that treating weakened ligaments helped patients avoid a hip replacement surgery and increase hip function.
Opposing Views Hyaluronic Acid Injections Provided Pain Relief Functional Improvement And No Severe Complications On An Immediate Short
In the Pakistani Journal of Ayub Medical College, doctors treating hip pain patients made these observations on the different molecular weights gels available. Was thicker better? There seemed to be no research on that. Here is what they wrote:
A multitude of conservative treatments is used for pain relief and functional improvement including acetaminophen, NSAID, intra-articular corticosteroid, and viscosupplementation. Different preparations of viscosupplementation based on different molecular weights are commercially available. The researchers then examined the use of intra-articular high molecular weight hyaluronic acid injection for the hip joint by reviewing four previous studies on Hyaluronic acid injections effectiveness.
- Results: Four studies comprising 185 and 189 patients in high molecular weight hyaluronic acid injection and control groups were included, respectively.
- Conclusions: Intra-articular high molecular weight hyaluronic acid injection provided pain relief, functional improvement, and no severe complications on an immediate short term basis. However, the results do not favor treatment with high molecular weight hyaluronic acid injection over other treatment methods
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