Dr. Zeid Al-Ani

Ultrasound-guided hip steroid injections

Steroid injections for hip joint and hip (trochanteric) bursitis.

This is a common ultrasound-guided treatment we perform for patients who have hip (trochanteric bursitis) or hip osteoarthritis.

What is a hip cortisone injection?

Corticosteroid (cortisone) is a potent anti-inflammatory medicine routinely used to manage inflammatory conditions (like bursitis, arthritis and tendinosis). A cortisone injection will reduce the inflammation in the injected area (like the hip joint or trochanteric bursa) and allow you to manage the condition, usually by undergoing an effective physiotherapy program.

What hip conditions can be effectively managed with an ultrasound-guided injection?

An ultrasound-guided hip injection/procedure can be useful in the management of:

What is hip (trochanteric) bursitis?

This inflammatory condition affects the tendons (and possibly the bursa) at the outside of the hip, causing pain and discomfort. The condition is usually caused by irritation of a special group of tendons (called the gluteal tendons) attaching to a bony prominence outside the hip (called the greater trochanter). Therefore, this condition is sometimes referred to as “gluteal tendonitis”. Sometimes, it is associated with inflammation of the adjacent "trochanteric bursa". The trochanteric bursa is a thin fluid-containing sac found outside the hip, next to the greater trochanter, hence the name of the condition. Trochanteric pain syndrome is an umbrella term for the different conditions that could affect this area. To find out more, please read our article about Hip trochanteric bursitis. The management of trochanteric bursitis starts with physiotherapy. An ultrasound-guided steroid injection can be very useful in the management when the condition is resistant to physiotherapy and other conservative measures.

What is hip osteoarthritis?

Hip osteoarthritis is a common cause of hip and groin pain, mostly affecting people over 50. It is usually progressive due to wear and tear changes to the hip joint articular cartilage, resulting in the loss of its protective, shock-absorbing function. If this progresses, there might be a complete loss of the articular cartilage, and the unprotected joint surfaces come into contact. This is usually called “bone on bone” and indicates severe osteoarthritis. Please read our article to find out more about the stages of hip arthritis. Ultrasound-guided hip joint steroid injections can be very useful in managing effective pain relief through their anti-inflammatory effect.

Should hip injections be done under ultrasound guidance?

Yes. This is our routine practice, as plenty of evidence supports ultrasound guidance when performing joint injections. Doing hip injections under ultrasound/imaging guidance allows for direct visualisation of the needle to ensure accurate placement into the area of pain/inflammation (like a bursa, an arthritic joint or an inflamed tendon sheath). Ultrasound guidance results in more accurate, less painful and faster procedures, with better outcomes than these injections without guidance. Ultrasound guidance avoids sensitive structures (like nerves and vessels) during the procedure.

In trochanteric bursa injections, ultrasound guidance ensures injecting the medicine accurately. Inadvertent administration of the steroid into the adjacent gluteal tendons can cause tendon weakening and thus should be avoided. An initial ultrasound assessment is very important for the same reason, as it will rule out the presence of a significant tendon tear.

Do I need a hip cortisone injection?

Generally, the management of most hip conditions starts with physiotherapy treatment and progressive rehabilitation. The duration of this depends on the condition. If the response from the above is poor or not satisfactory, then an ultrasound-guided hip treatment option may be considered. Injection therapy can be very useful in reducing pain and improving function, allowing for more effective rehabilitation. We always advise performing hip injections under ultrasound guidance by an experienced doctor to ensure accurate medicine delivery to the targeted area.

What are the common steroid types used in hip joint injections?

The most commonly used type of steroid injections for hip arthritis and bursitis are Methylprednisolone (Depo-medrone) and Triamcinolone acetonide (Kenalog). These are long-acting preparations that take a few days to start working.

How long will the cortisone injection effect last?

Current evidence suggests that cortisone can improve pain and function for up to 3 months, but in some cases, it can last longer. The injections usually also contain a local anaesthetic that provides immediate pain relief lasting a few hours.

Are hip cortisone injections safe?

These injections are generally very safe and routinely done in our practice. There is a very small risk of infection (about 1:10.000). There is a possibility that the injected area will feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection. The procedure will be explained in detail during your appointment, and all your questions will be addressed. To find out more about cortisone injection in general, please see our FAQs.

Do hip steroid injections just hide/mask the pain?

Steroid injections do not just mask or hide the pain, but they reduce the inflammation in the targeted area, thus providing a strong and local anti-inflammatory effect to help control the symptoms and allow the patient to manage the condition, usually by undergoing effective rehabilitation.

How many hip injections can I have?

We recommend reducing the number of cortisone hip injections by combining any injection therapy with an effective physiotherapy programme to address the underlying cause. Repeated steroid injection into the same area should be avoided if the previous injection was less than 3-4 months ago.

Are hip injections painful?

Generally, hip injections are well-tolerated, and most patients experience very little discomfort during the procedure. The corticosteroid is usually mixed with a local anaesthetic (numbing medicine) to relieve the pain. We use ultrasound guidance to ensure the procedure is quick and efficient. Ultrasound ensures needle visualisation to choose the safest path for the injection and avoid any critical or sensitive structures.

Will my hip hurt after a cortisone injection?

There is a possibility that the injected area will feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection. Not all people feel this, and the discomfort is minimal in most cases. Usually, resting the area for a few days and avoiding strenuous activities is sufficient. Painkillers and anti-inflammatory tablets can also help control the pain until the steroid effect starts.

How long should I rest after a hip injection?

Usually, we advise patients to rest for 48 hours after having a hip injection. This can vary depending on the type of treatment and severity of the condition.