From the Guidelines
Hip injections can be performed for pain management in patients with metastatic cancer to the hip, but with important considerations, as supported by the most recent study 1 from 2022. The procedure should be done in consultation with the patient's oncologist and pain management specialist. Corticosteroid injections (such as methylprednisolone 40-80mg or triamcinolone 40mg) mixed with local anesthetic (like lidocaine 1%) can provide temporary relief. However, these injections are palliative, not curative, and should be part of a comprehensive pain management strategy that may include systemic analgesics, radiation therapy, and other oncological treatments.
There are specific risks to consider:
- the injection could potentially spread cancer cells (though this risk is theoretical),
- infection risk is higher in immunocompromised patients,
- and bleeding complications are more likely if the patient has coagulopathy from their cancer or treatments. The injection should be performed under image guidance (fluoroscopy or ultrasound) to ensure accurate placement and avoid tumor disruption, as suggested by studies on minimally invasive techniques for bone pain management 1.
The benefits of pain relief must be weighed against these risks, and the patient should understand that relief may be temporary, typically lasting weeks to months. It is also important to consider the use of bone-modifying agents such as bisphosphonates or RANK ligand inhibitors, as recommended by the NCCN guidelines 1, to reduce the risk of skeletal-related events and improve quality of life.
In terms of specific considerations for hip injections in patients with metastatic cancer,
- the procedure should be individualized based on the patient's overall health status,
- the extent of their disease,
- and their response to other treatments. Additionally,
- the patient's performance status,
- their ability to tolerate the procedure,
- and their expected survival should all be taken into account when deciding whether to proceed with a hip injection. Overall, hip injections can be a useful adjunct in the management of pain from metastatic cancer to the hip, but should be used judiciously and as part of a comprehensive treatment plan, as supported by the evidence from 1 and 1.
From the Research
Hip Injections for Metastatic Cancer
- There is limited research directly addressing the performance of hip injections on individuals with hip pain from metastatic cancer 2, 3, 4, 5, 6.
- However, studies suggest that corticosteroids are commonly prescribed as adjuvant therapy for painful bone metastases, including hip pain 3.
- Intraarticular hip injections with corticosteroids have been shown to be effective in providing pain relief for patients with hip osteoarthritis, but the evidence for their use in metastatic cancer is limited 4.
- Radiation therapy is also an effective treatment for painful uncomplicated bone metastases, but the optimal dose and schedule for maximum pain relief remains unclear 5.
- A study on femoroacetabular impingement syndrome found that a formal nonoperative management program combining a hip injection with structured adjunctive exercise rehabilitation can be beneficial for patients with symptomatic FAIS 6.
Considerations for Hip Injections
- The use of hip injections for metastatic cancer should be approached with caution, as the evidence is limited and the potential risks and benefits need to be carefully considered 2, 3, 4, 5, 6.
- Clinicians should be aware of the potential risks of septic arthritis and chondrotoxic effects of local anesthetics when performing hip injections 4.
- The decision to perform a hip injection on a person with hip pain from metastatic cancer should be made on a case-by-case basis, taking into account the individual's overall health, prognosis, and treatment goals 2, 3, 4, 5, 6.