Cortisone injections are a common treatment for hip pain caused by conditions like osteoarthritis, bursitis, and tendinitis. The injections deliver a powerful anti-inflammatory steroid medication directly into the affected area to reduce inflammation and relieve pain. For many patients, a single cortisone injection can provide months of pain relief. However, cortisone shots don’t always work, and the pain relief may be temporary or incomplete. This article explores what happens when a cortisone injection in the hip doesn’t provide the expected pain relief.
Why Might a Cortisone Shot Not Work?
There are several reasons why a cortisone injection may fail to deliver adequate pain relief:
- Incorrect diagnosis – The hip pain may be caused by a condition that doesn’t respond well to cortisone, such as a labral tear or avascular necrosis.
- Severe joint damage – If the hip joint is severely damaged from advanced osteoarthritis, the anti-inflammatory effects of cortisone may not be enough to reduce pain.
- Improper injection technique – If the medication isn’t injected in the right location, it won’t reach the inflamed tissue.
- Underlying mechanical problems – Issues like muscle imbalances or leg length discrepancy can continue to cause pain despite the anti-inflammatory effects of cortisone.
- Development of tolerance – With repeated injections, the body may become tolerant to cortisone, reducing its effectiveness.
Essentially, if the source of pain is something other than inflammation, or there are significant structural problems in the hip joint, a cortisone shot may only provide partial, temporary relief at best.
What Happens if Cortisone Shot Doesn’t Work?
If a single cortisone injection doesn’t provide sufficient pain relief, there are a few options:
- Try another injection – Sometimes a repeat injection in the same area provides better results. However, benefits tend to diminish with more than 3-4 injections in a year.
- Use imaging guidance – Ultrasound or fluoroscopic guidance can improve accuracy of delivery into the inflamed tissue.
- Change injection site – A different specific area of the hip may respond better than the initial location.
- Use a different steroid – Other types of corticosteroids may work better for some patients.
- Combine with anesthetic – Adding a numbing medication like lidocaine can provide immediate, short-term relief.
If repeat cortisone injections fail to provide adequate pain relief, the next steps may involve surgery or other interventional procedures:
- Hip arthroscopy – This type of keyhole surgery allows the surgeon to repair damaged tissue and remove inflamed synovium inside the hip joint.
- Total hip replacement – For patients with severe osteoarthritis, a hip replacement may be the best option to permanently eliminate joint pain.
- Alternative injections – Platelet rich plasma (PRP) or hyaluronic acid injections may provide relief when cortisone fails.
- Radiofrequency ablation – Using heat to destroy nerves carrying pain signals from the hip joint.
How Long Does Pain Relief from Cortisone Injection Last?
When cortisone hip injections are effective, the duration of pain relief can vary substantially depending on the underlying condition, dosage, and the patient’s response. Some general guidelines:
- Osteoarthritis: 4-6 weeks of relief is typical, sometimes longer.
- Trochanteric bursitis: 2-3 months relief on average.
- Piriformis syndrome: 1-2 months before pain may return.
- Hip tendinitis: Relief may last approximately 6-12 weeks.
With conditions like advanced osteoarthritis, the effects of cortisone diminish with each repeated injection. Most doctors recommend no more than 3-4 injections per year into the same site.
Risks and Side Effects
Cortisone injections are generally safe with few complications. However, possible risks include:
- Bleeding, infection or nerve injury from needle placement
- Thinning of cartilage and weakening of bone with repeated injections
- Lightening of skin pigmentation around the injection site
- Temporary increase in pain for 1-2 days
- Facial flushing, elevated blood sugar, and interference with menstrual cycle
Serious complications like joint infection, cartilage breakdown, and bone death (osteonecrosis) are very rare. Doctors typically take precautions like using sterile technique and alternating injection sites to minimize risks.
Factors Affecting Cortisone Injection Effectiveness
Certain factors can influence the likelihood of a cortisone shot providing effective, lasting pain relief:
Factor | Details |
---|---|
Underlying condition | Conditions caused purely by inflammation respond best. Structural problems less likely to have lasting relief. |
Age | Younger patients may have better response than older patients. |
Obesity | Excess weight increases force across hip joint, reducing effectiveness. |
Activity level | The more active the patient, the poorer the response may be. |
Injection accuracy | Precise delivery into inflamed tissue improves results. |
Hip joint health | Advanced joint damage reduces responsiveness. |
Combination therapy | Combining with other treatments may enhance pain relief. |
Discussing these factors with your doctor can help determine if a cortisone injection is likely to be effective in your specific case.
When to Seek Medical Attention
You should seek prompt medical care if you experience:
- Signs of joint infection – fever, intense pain, redness, warmth, swelling, or drainage from the injection site.
- Sudden severe hip pain – this could indicate a rare complication like cartilage collapse or joint fracture.
- Inability to bear weight on the leg – may signal a significant injury.
- Significant increase in pain lasting more than 2 days after injection.
- Rash, hives, difficulty breathing – potential allergic reaction.
Routine side effects like flushed face, insomnia, headache, or transient pain flare can usually be managed with rest, ice, over-the-counter pain medication, and time. But worsening symptoms or new severe symptoms warrant medical evaluation to rule out serious problems.
Conclusion
For optimal results, cortisone injections for hip pain should be part of a comprehensive treatment plan that addresses the underlying condition. Though generally safe, injections do carry some risks and are often ineffective long-term when used in isolation without additional treatments. Work closely with your doctor to determine if cortisone shots are the right option for your hip pain, and have realistic expectations about potential benefits and limitations.