Is a cortisone (corticosteroid) shot effective for treating hip pain?

Cortisone Injections for Hip Pain

Intra-articular corticosteroid injections are effective for hip osteoarthritis pain and are strongly recommended by major guidelines, but they must be performed with ultrasound or fluoroscopic guidance due to the hip's anatomical complexity. 1

Evidence-Based Recommendations

When to Use Corticosteroid Injections

Corticosteroid injections are strongly recommended for hip osteoarthritis with persistent pain that has not responded adequately to first-line treatments (NSAIDs, acetaminophen, physical therapy). 1

• The American College of Rheumatology/Arthritis Foundation provides a strong recommendation for intra-articular glucocorticoid injections in hip OA, indicating high confidence in the benefit-to-risk ratio. 1
• The VA/DoD guidelines suggest offering corticosteroid injections for persistent hip OA pain inadequately relieved by other interventions. 1

Clinical Efficacy

Pain relief from hip corticosteroid injections is significant but time-limited, typically lasting weeks to months rather than providing long-term benefit. 2

• A prospective randomized trial demonstrated significant pain reduction at 3 and 12 weeks post-injection with 80 mg triamcinolone acetonide, with pain at rest improving most dramatically. 2
• Joint range of motion increased significantly in all directions, and functional ability improved significantly after injection. 2
• The control group receiving only local anesthetic showed no significant pain relief or functional improvement, confirming the therapeutic effect is from the corticosteroid itself. 2

Critical Technical Requirement

Image guidance (ultrasound or fluoroscopy) is mandatory for hip injections—this is a strong recommendation, not optional. 1

• Unlike knee injections where imaging is optional, hip joint depth and proximity to neurovascular structures make blind injection unsafe and unreliable. 1
• The ACR Appropriateness Criteria rates image-guided anesthetic + corticosteroid injection as "usually appropriate" (rating 8/9) when trying to exclude the hip as a pain source in patients with concurrent back, pelvic, or knee pathology. 1

Important Caveats and Limitations

Timing Relative to Surgery

Avoid corticosteroid injection within 3 months before planned total hip arthroplasty due to theoretical infection risk. 1

• While the VA/DoD systematic review found limited data on elevated deep joint infection risk, this precaution remains standard practice. 1

Disease Progression Concerns

Repeated corticosteroid injections may be associated with accelerated progression to total hip arthroplasty, particularly in non-arthritic hips. 3

• A large database study found patients receiving hip corticosteroid injections had significantly higher rates of THA at 5 years (1.1% vs 0.5%) compared to matched controls. 3
• Risk increased in a dose-dependent manner: 1 injection (0.8%, OR 1.37), 2 injections (1.1%, OR 1.45), ≥3 injections (1.5%, OR 1.48). 3
• The ACR acknowledges potential cartilage loss but notes this wasn't associated with worsening pain or function in clinical trials. 1, 4
• The VA/DoD explicitly states providers must consider potential long-term negative effects on bone health, joint structure, and meniscal thickness with repeat injections. 1, 4

Diagnostic vs. Therapeutic Use

For patients fit for surgery with established hip OA, corticosteroid injection provides minimal delay to eventual hip replacement—70% proceeded to surgery in one series. 5

• Diagnostic injections (to differentiate hip from back pain) have clearer utility, with only 20% proceeding to surgery. 5
• In adolescents with femoroacetabular impingement (FAI), 90% with cam or pincer morphology required surgery after injection, while 90% without bony abnormalities improved with injection alone. 6

Comparison to Alternatives

Corticosteroid injections are preferred over hyaluronic acid preparations, as the evidence quality for glucocorticoid efficacy is considerably higher. 1, 4

Practical Algorithm

1. Confirm hip OA diagnosis with radiographs showing osteoarthritic changes
2. Ensure adequate trial of first-line treatments (NSAIDs, physical therapy, weight management)
3. Assess surgical candidacy: If patient is fit for surgery with advanced OA, proceed directly to arthroplasty consultation rather than injection 5
4. For persistent pain in surgical non-candidates or earlier-stage disease: Offer image-guided corticosteroid injection 1
5. Limit frequency: Given dose-dependent progression risk, avoid routine repeat injections 3
6. Avoid within 3 months of planned arthroplasty 1