Short answerA cortisone injection into the hip eased pain more than advice alone. The benefit was clear at two weeks and two months, and had faded by six months.
Evidence grade
Does not helpNot enough evidenceHelps a littleGood evidence
Probably helps a little, for a short time
What it is
A cortisone injection places a steroid medicine and a local anaesthetic into the hip joint, usually guided by ultrasound or X-ray. It aims to settle inflammation in the joint.
What the research shows
enrolled 199 adults in England with hip arthritis and at least moderate pain. One third received advice and education only. One third also had an ultrasound-guided injection of triamcinolone with lidocaine. One third had an injection of lidocaine alone.
Over six months, pain was lower with the cortisone injection than with advice alone, by an average of 1.4 points on a 10 point scale. The gain was largest at two weeks, about 3 points, and at two months, about 2 points. There was no significant gain in pain at four or six months. Function was better up to four months.
The difference between cortisone with lidocaine and lidocaine alone was not significant over six months. The trial was not designed to settle that comparison. Participants knew whether they had an injection or not, which may have exaggerated the gap with advice alone. People whose ultrasound showed inflamed joint lining or fluid did better with cortisone.
Risks and effort
Skin thinning or whitening at the injection site and hot flushes each occurred in 4 of 66 people given cortisone. One person with an artificial heart valve died from a heart valve infection four months after the injection, which the trial team judged possibly related. The authors advised caution in anyone at risk of infection.
The trial tested a single injection. The authors said more research is needed on repeated injections.
Who is most likely to benefit?
People with signs of inflammation on ultrasound did better in this trial.
Why are some doctors cautious about cortisone injections in the hip?
Three reasons. The benefit fades, and in the HIT trial it had gone by four to six months. Any injection into a joint carries a small risk of infection. And if you might need a hip replacement, an injection in the three months before surgery has been linked to a higher chance of infection in the new joint. A review of 11 studies with 173,465 hip and knee replacements found the odds of joint infection were about 1.4 times higher when a steroid injection had been given within three months of surgery, with no clear increase when it was given three to twelve months before . A review of hip replacements alone pointed the same way . These studies looked back at records, so they show a link, not proof of cause.
How successful are cortisone injections in the hip?
In the HIT trial, pain was about 3 points lower on a 10 point scale at two weeks and about 2 points lower at two months than with advice alone. By four to six months there was no clear difference. People whose ultrasound showed an inflamed joint lining or fluid did better.
What should I avoid after a hip injection?
The trial did not test aftercare. Seek help the same day if the hip becomes hot, red and increasingly painful, or you develop a fever, as these can be signs of infection. If you have diabetes, check your blood sugar more often for a few days. If you are waiting for a hip replacement, tell your surgeon about any recent injection.
