Common Symptoms and Side Effects of Hip Cortisone Injections
Hip corticosteroid injections commonly cause injection-site soreness, facial flushing/sweating, and transient pain exacerbation, with most side effects being mild and self-limited. 1
Immediate and Early Side Effects (Within Hours to Days)
Most Common Reactions
- Injection-site soreness is the most frequently reported delayed adverse event, occurring in approximately 13% of patients 1
- Vasovagal reactions (lightheadedness, fainting) occur in approximately 2.5% of patients during or immediately after the procedure 1
- Facial flushing and/or sweating are corticosteroid-specific side effects that occur in a small percentage of patients (approximately 2% based on sacroiliac joint data) 1
Pain-Related Reactions
- Post-injection pain flare can occur, with approximately 5% of patients experiencing pain exacerbations in the days following injection 1
- Pain typically increases temporarily before improvement occurs 1
- Average duration of meaningful pain relief is relatively short, approximately 6.7 weeks, though this varies considerably between patients 2
Systemic Corticosteroid Effects
Metabolic Effects
- Transient hyperglycemia is a significant concern, particularly in diabetic patients, with blood glucose levels typically increasing during days 1-3 post-injection 1
- Patients with diabetes should monitor glucose levels closely during this period 1
Endocrine Effects
- Development of cushingoid features with repeated injections 3
- Menstrual irregularities in women 3
- Suppression of the hypothalamic-pituitary-adrenal axis with chronic use 1
Musculoskeletal Concerns
Joint-Specific Risks
- Aseptic necrosis of the femoral head is a rare but serious complication listed in FDA labeling 3
- Potential cartilage changes with repeated injections, though clinical significance remains uncertain 1
- Charcot-like arthropathy with chronic use 3
Bone Health
- Decreased bone mineral density with possible increased fracture risk with repeated injections 1
- Osteoporosis development with long-term or repeated use 3
Rare but Serious Complications
Infectious Risks
- Joint infection is extremely rare but documented in case reports 1
- Immunosuppression increases infection susceptibility generally 1, 3
- Risk is higher in immunocompromised patients 1
Neurologic Events
- Transient sciatic nerve block can occur if the injection penetrates the anterior hip capsule, creating fall risk 1
- This is more common when local anesthetic is included in the injectate 1
Cardiovascular and Other Systemic Effects
- Hypertension, fluid retention, and hypokalemic alkalosis are possible 3
- Bradycardia, cardiac arrhythmias (especially in patients on digitalis) 3
- Thromboembolism risk 3
Important Clinical Considerations
Timing Relative to Surgery
- Corticosteroid injections should be avoided within 3 months of planned hip replacement surgery due to potential increased infection risk (from 0.5% to 1.0%) 1
Duration of Benefit
- Most patients experience limited long-term benefit, with only 37% reporting clinically significant pain reduction at 14 days and only 6% at 6 weeks 4
- Mean duration of relief is approximately 9.8 days in patients with hip pathology 4
Gastrointestinal Effects
- Increased risk of peptic ulcer disease, particularly when combined with NSAIDs 3
- Nausea and abdominal distention 3