Hip Arthritis Injections vs Surgery

What injections are useful for hip arthritis?

There are three types of injections to consider when treating hip arthritis. While steroid injections are discussed in more detail, there are two other possible injections for hip arthritis that will be briefly discussed here but are not routinely used in the hip.

Steroid

1. The most well-studied and frequently used injection type for hip arthritis is a steroid injection. This injection is comprised of a short acting local anesthetic that wears off within a few hours and a long acting steroid which works to reduce the inflammation in the joint. This inflammation is what is responsible for the classic symptoms of hip arthritis.
2. It is difficult to determine for how long the anti-inflammatory effect of the steroid injected to the hip joint can provide durable relief. Some patients have an excellent response to the injection with relief lasting greater than six months whereas some patients only have a couple weeks of relief. In cases where there is more severe arthritic degeneration, the beneficial effect of a steroid injection can be quite limited. For patients that have a reasonable response to their hip injection, injections can actually be repeated every three months.
3. However, caution should be taken especially in mild cases of hip arthritis as there are some studies suggesting there may be a catabolic effect to the cartilage from the steroid. Additionally, one other consideration is a hip replacement should not be performed within three months of receiving a steroid injection, as this does increase the risk of infection after hip replacement.

Hyaluronic acid (HA)

1. Viscosupplementation or “gel” injections are comprised of hyaluronic acid. HA is naturally found in our joint synovial fluid and providing HA in the form of a gel injection works to provide pain relief, lubrication, modulation of inflammatory mediators, and may have a role in stimulating cartilage matrix synthesis
2. However, these gel injections are not FDA approved for hip arthritis currently and have limited evidence for their use in the hip.
3. Nonetheless, if a patient does want to try a gel injection, it may be worth having a conversation regarding its utility

Platelet rich plasma (PRP)

1. PRP has very limited evidence for hip arthritis and is not routinely recommended. Briefly, the technique of PRP basically involve taking a small sample of the patient’s own blood, mixing it down to the platelets and growth factor layers, and injecting those via ultrasound or radiographic guidance precisely into the hip joint
2. Similar to the discussion regarding viscosupplementation, while PRP has limited evidence compared to steroids for treating hip arthritis is a potential conversation to consider as an option before considering surgery.

What is the role of surgery in hip arthritis?

If patients after several months of sustained and reasonable non-operative treatment of hip arthritis still do not have a reasonable quality of life and worsening function with x-rays that match their clinical picture, then we can consider hip replacement at that point.

In thinking about various surgical options such as hip Arthroscopy, hip Resurfacing, reorienting hip Osteotomies, and Total Hip Arthroplasty (THA), the definitive surgical option that has the most proven track record and durability to restore function, improve quality of life, improve mobility, and eliminate pain is undergoing a THA to replace the hip joint. What is truly humbling and encouraging to hear regarding total hip replacement is that a THA has one of the strongest positive improvements on quality of life amongst all orthopedic surgeries that could be performed. For many patients, undergoing a total hip replacement can be a radically life changing event for a patient and truly give them a renewed sense of independence, mobility, and quality of life.

There are certainly risks with undergoing a THA such as hip dislocation, blood clots, implant failure such as wear of the polyethylene component, and infection. These risks among others are discussed in detail preoperatively and all patients will undergo a thorough preoperative evaluation and risk stratification including seeing their primary care provider, labwork and heart studies, and specialist clearances when needed to ensure surgery is done in a safe manner. It is essential that prior to undergoing a THA, the patient is well informed of the risks, benefits, alternatives, and postoperative rehabilitation. The surgeon and the patient must be aligned regarding these crucial factors and have shared goals and decision making regarding proceeding with a hip replacement.

After surgery, patients will be closely followed in the clinic at set time intervals as well as progressing with physical therapy. Therapy will focus on restoring a normal gait pattern, reducing swelling and pain control, restoring motion, improving strength, and gradually getting a patient back to their activities. Most patients are able to resume normal low-impact activities with their new hip replacement around 3 months after surgery. Many patients are delighted to hear that golfing activities are allowed at 3-6 months out from surgery though if their lead leg has been operated on, this may take just a bit longer. With our current hip replacement components and barring significant complications, hip replacements can last for 15-20 years or even longer. During this time, annual follow-up with the patient’s hip surgeon is essential to make sure there are no early issues with their hip and that they are doing well.

If you have symptoms consistent with hip arthritis, you are always welcome to call our office or book an appointment with hip surgeon Dr. Charls. Dr. Charls takes great care in diagnosing and treating hip arthritis on an individualized, patient specific basis. Dr. Charls sees patients at his Paris office at Paris Orthopedics and Sports Medicine and operates at both Paris Surgery Center and Paris Regional Health.