Can i get a cortisone shot in my hip

Osteoarthritis is a common and potentially debilitating condition. It’s a degenerative joint disease (often called the "wear-and-tear" type) in which the smooth lining of cartilage becomes thinned and uneven, exposing the bone beneath.

Although osteoarthritis is tightly linked with aging, we now know there is more to it than age alone: genetics, weight, physical activity, and a number of other factors can conspire to make it more likely that someone will develop osteoarthritis while someone else won’t. Osteoarthritis is the primary reason that more than a million joints (mostly hips and knees) are replaced each year in the US.

Treatments short of surgery can help but they don’t always work well, don’t cure the condition, and may be accompanied by side effects. Surgery is usually the last resort, reserved for people who have declining function, unrelenting pain, or both despite trying other treatments such as pain relieving, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, others) or naproxen (Aleve, others), or injections of steroids or hyaluronic acid (a type of lubricant). Nonmedication approaches can also help, such as loss of excess weight, physical therapy, or use of a cane or brace.

Calling steroid injections into question

Steroid injections can quickly relieve inflammation in the joints, and the effects may last from several weeks to several months. I’ve seen a number of patients who got significant relief from steroid injections every three or four months. But, a new report of one medical center’s experience and a review of past research came to some concerning conclusions about joint injections for osteoarthritis of the hip or knee. These included:

• a lack of compelling evidence that they work
• about 7% to 8% of people getting steroid injections seem to worsen, with their arthritis accelerating "beyond the expected rate"
• unusual fractures may occur (in about 1% of people)
• bone damage (called osteonecrosis) (in about 1% of people).

Other side effects include a temporary increase in blood sugar, bleeding into the joint, and, quite rarely, infection. And, of course, the injection itself can be painful, although numbing medication is usually provided.

The authors suggest that doctors order x-rays before each injection and not perform injections if there is evidence of any of these complications or unexplained pain. However, it’s not clear how effective this approach would be.

Now what?

The findings of this report regarding injections of steroids for knee and hip osteoarthritis are disappointing, especially for those who have not improved with other treatments.

Regarding the benefit of the injections, it’s important to keep in mind that even if the average benefit of a treatment is small, it does not mean that treatment is useless. Though temporary, some people do report significant improvement with steroid injections.

It’s also not entirely clear that the problems described in this study are actually caused by the steroid injections. And, from my own experience, the rates of complications seem high to me. That said, a 2017 study did find that people getting steroid injections had more thinning of joint cartilage than those getting placebo injections.

In my own practice, I’ll still offer a steroid injection for osteoarthritis, but only after carefully reviewing the potential risks and benefits. If it is not terribly helpful, I would not encourage repeated injections. On the other hand, if it works well, a limited number of injections (up to three or four per year is a common limit) may reduce pain and improve function and quality of life.

Restricting the injections to those who improve the most and limiting the number of injections each year may be a better strategy than eliminating steroid injections altogether, especially since the most serious side effects are quite rare.

We’ll need additional studies that examine the type, dosage, and frequency of steroid injections that might provide more benefit than risk. And we’ll need better ways to predict who will improve the most. Until then, I think it’s important to keep an open mind about just how helpful — and how safe — steroid injections for osteoarthritis truly are.

In this article, Mr Mandeep Lamba (Consultant Orthopaedic Surgeon at The Holly Private Hospital) answers frequently asked questions about steroid injections.

Millions of people worldwide are affected by joint conditions, such as:

• osteoarthritis (when joints become painful and stiff)
• tendonitis (the swelling of a tendon, which is a thick cord attaching a muscle to a bone)
• bursitis (the painful swelling of a joint, often caused by repetitive movement or an injury)

These conditions can cause debilitating pain and major problems with movement. If lifestyle changes and oral medications do not relieve your symptoms, you may be offered steroid injections to treat painful knees or hips.

What is a steroid injection and how can it help?

Steroid injections are used to treat painful musculoskeletal conditions in the lower limbs, including:

• osteoarthritis of the hips and knees
• inflammatory joint disease
• other conditions affecting the joints

You usually have steroid injections in the outpatient department of a hospital. The injection itself takes only a few minutes.

Are steroid injections safe?

Steroid injections are a safe, quick and proven way to relieve joint pain and inflammation (swelling).

Most patients’ symptoms improve within a few days. Pain relief can often last for several months.

Is a steroid injection painful?

Like any injection, a steroid injection can be a bit uncomfortable at the time. Any discomfort is only temporary. You also have a local anaesthetic to make the area that is treated numb. This means that you experience as little pain as possible.

Do steroid injections have any side effects?

Occasionally, there may be a flare-up of joint pain within the first 24 hours after a steroid injection. This usually settles by taking simple painkillers like paracetamol. Other side effects include infection, bruising and skin discolouration, but these happen very infrequently.

Will steroid injections make me put on weight?

A small amount of steroid is used and accurately placed into the joint. This means that the effects on the rest of your body are minimal.

The steroids in the injections are medically proven to be effective for joint pain. They are not anabolic or oral steroids associated with weight gain.

Will steroids increase my chance of getting coronavirus (Covid-19)?

Steroids work by reducing inflammation. They are injected into the joint or nearby soft tissues and never into the bloodstream. Recent evidence shows that musculoskeletal steroid injections do not increase your risk of getting coronavirus.

It is recommended, however, that you wait at least two weeks either side of your coronavirus vaccine before having a steroid injection.

Are steroid injections effective?

In most cases, a single steroid injection is sufficient but in other cases you may need another injection. This may be part of a treatment plan that includes analgesics (pain-relieving drugs) and physiotherapy. You can safely have steroid injections more than once a year if this is considered to be medically necessary.

In some situations, you may need to have ultrasound-guided steroid injections. Specialist musculoskeletal radiologists give these injections. They help to ensure that the needle is placed more accurately at the area causing your pain.

If steroid injections do not result in a lasting improvement, you may need to consider other options such as surgery.

About Mr Mandeep Lamba

Mr Mandeep Lamba, Consultant Orthopaedic Surgeon, has regular clinics at The Holly Private Hospital. To book an appointment, please call 020 3504 8481 or complete this form online.

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