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Hip pain procedures

Persistent hip pain can be treated by blocking the nerves supplying the joint, or by injecting the joint itself. This is particularly useful for people waiting for hip replacement, or for whom surgery is not suitable.

Pain felt around the hip does not always come from the hip joint. Referred pain from the lumbar spine, gluteal tendon problems, and bursitis all present similarly, and imaging showing hip arthritis does not confirm the arthritis is what hurts. Establishing the source is the first task.

Diagnostic injection. An image-guided injection of local anaesthetic into the hip joint answers the question directly. Substantial relief while the anaesthetic is active indicates the joint is the source. Little or no relief points elsewhere — most often the spine or the gluteal tendons — and redirects treatment accordingly.

Nerve blocks and radiofrequency. The hip joint receives sensory supply from branches of the femoral and obturator nerves. These can be blocked diagnostically and, where the response is good, treated with radiofrequency to give longer relief. This is a useful option for people with significant arthritis who are on a long surgical waiting list, or who are not suitable for joint replacement because of other health problems. It does not treat the arthritis; it treats the pain.

Joint injections. Anti-inflammatory medication injected into the joint under image guidance can reduce pain for a period that varies widely between individuals.

Platelet-rich plasma and hyaluronic acid. Both are available in selected cases. The evidence in hip osteoarthritis is weaker than in the knee, and the knee evidence is itself inconsistent — significant placebo-controlled trials have failed to show benefit over placebo. Neither attracts a Medicare rebate. Dr Martin will give you a straight assessment of whether it is likely to be worth it in your case.

On the day. Hip procedures are performed under X-ray or ultrasound guidance and take 20–30 minutes. Light sedation is available. Arrange a driver if sedated.

Risks. Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

What else matters. Hip pain almost always benefits from work on strength and gait. Where surgery is appropriate, Dr Martin will say so and refer.