Hip Injections

Hip Injections

Hip joint injections involve injecting medicine directly into the hip joint to diagnose the source of pain or treat pain due to conditions such as arthritis, injury or mechanical stress of the hip joint. Hip pain may be experienced in the hip, buttock, leg or low back. The injection contains a combination of a numbing medicine and cortisone (an anti-inflammatory agent). Numbing medicine delivers temporary relief from pain, provided the hip joint is the source of the pain. It thus serves a diagnostic function and helps to confirm or deny whether the joint is the source of pain. Cortisone serves to reduce the inflammation in the joint providing long term pain benefit.

Procedure

If needed, a relaxation medicine is given to the patient through an IV line. The patient lies face down on an X-ray table. The small area where the injection needs to be given is numbed with an anesthetic. The patient may feel a sting for a few seconds. A small needle is then accurately placed by the doctor into the joint guided by the real time X-ray images (fluoroscopy). Before injecting the medicine, a contrast dye is injected through this needle into the joint to confirm that the medicine will reach the joint. A combination of anesthetic and anti-inflammatory cortisone is then slowly injected into the joint. The whole procedure usually takes about 30 to 60 minutes.

After the procedure

After the injection the patient is made to rest for 20 to 30 minutes and is then asked to move the joint, provoking pain. The patient may or may not find a decrease in pain depending on whether the injected joint is the main source of the pain. The patient is also asked to maintain a record of relief in pain during the coming week. Physical therapy may also be recommended. Even when pain relief is significant the patient should increase activities gradually over one to two weeks to avoid reappearance of pain.

Risk and complications

The possible risks of hip injections include: swelling and pain in the joint after the injection, infection, depigmentation of skin, local thinning of the skin and rupture of a tendon.

If the injected hip joint is the source of the pain, the pain may reduce two to five days after the injection. However, if no improvement is found within ten days after the injection further diagnostic tests may be required to ascertain the cause of pain.

Hip Arthroscopy

Hip arthroscopy, also referred to as keyhole surgery or minimally invasive surgery, is performed through very small incisions to evaluate and treat a variety of hip conditions. Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. Arthroscopy is a term that comes from two Greek words, arthro-, meaning joint, and -skopein, meaning to examine. Arthroscope is a pencil-sized instrument that has a small lens and lighting system at its one end. Arthroscope magnifies and illuminates the structures inside the body with the light that is transmitted through fiber optics. It is attached to a television camera and the internal structures are seen on the television monitor.

Indications

Hip arthroscopy may be indicated in following conditions:

• Debridement of loose bodies: Bone chips or torn cartilage debris cause hip pain and decreased range of motion and can be removed with hip arthroscopy.
• Removal of adhesions: Adhesions are areas of built up scar tissue that can limit movement and cause pain.
• Repair of torn labrum: The labrum lines the outer edge of the “socket” or acetabulum to ensure a good fit. Tears can occur in the labrum causing hip pain.
• Removal of bone spurs: Extra bone growth caused by injury or arthritis that damages the ends of the bones cause pain and limited joint mobility.
• Partial Synovectomy: Removal of portions of the inflamed synovium (joint lining) in patients with inflammatory arthritis can help to decrease the patient’s pain. However, a complete synovectomy requires an open, larger hip incision.
• Debridement of joint surfaces: Conditions such as arthritis can cause the breakdown of tissue or bone in the joint.
• Repair after Trauma: Repair of fractures or torn ligaments caused by trauma.
• Evaluation and diagnosis: Patients with unexplained pain, swelling, stiffness and instability in the hip that is unresponsive to conservative treatment may undergo hip arthroscopy for evaluation and diagnosis of their condition.

Procedure

Hip arthroscopy is performed under regional or general anesthesia depending on you and your surgeon’s preference. Your surgeon will make 2 or 3 small incisions about 1/4 inches in length around the hip joint. Through one of the incisions an arthroscope is inserted. Along with it, a sterile solution is pumped into the joint to expand the joint area and create room for the surgeon to work.

The larger image on the television monitor allows the surgeon to visualize the joint directly to determine the extent of damage so that it can be surgically treated. Surgical instruments will be inserted through other tiny incisions to treat the problem. After the surgery, the incisions are closed and covered with a bandage.

Advantages

The advantages of hip arthroscopy over the traditional open hip surgery include:

• Smaller incisions
• Minimal trauma to surrounding ligaments, muscles, and tissues
• Less pain
• Faster recovery
• Lower infection rate
• Less scarring
• Earlier mobilization
• Shorter hospital stay

Risks and Complications

As with any surgery, there are potential risks and complications involved. It is very important that you are informed of these risks before you decide to proceed with hip arthroscopy surgery. Possible risks and complications include:

• Infection at the surgical incision site or in the joint space
• Nerve damage which may cause numbness, tingling, pain, and weakness
• Excess bleeding into the joint, a condition called hemarthrosis
• Blood clots may form inside the deep veins of the legs which can travel to the lungs (pulmonary embolism).

Post-Operative Care
Your doctor may advise you to take certain precautions to promote faster recovery and prevent further complications. These include:

• Taking pain medications as prescribed.
• Use of crutches to prevent or limit bearing weight on the operated hip
• Physical therapy exercises should be performed to restore normal hip function and improve flexibility and strength
• Eating a healthy diet and avoiding smoking will help in faster healing and recovery
• Avoid activity which involves lifting heavy things or strenuous exercises for first few weeks after surgery