This is both a diagnostic and therapeutic procedure performed as a day case.
It is diagnostic in that it is sometimes used to be certain that the pain is coming from the hip joint before other surgery is planned. Hip pain sometimes can be referred from the back or pelvis. This test helps to discriminate between those causes.
Therapeutically it can also be very useful. For a range of hip conditions, including osteoarthritis, it can give a good relief of symptoms from anywhere from a few months up to one to two years.
The procedure involves inserting a very fine needle into the hip joint under x-ray control then injecting local anaesthetic and cortisone into the hip. The hip is manipulated to get the injected material all the way around the hip but also to break down adhesions around the hip to restore the range of movement.
The procedure can be performed under local anaesthetic but is normally performed under a short general anaesthetic. In both instances the operation is performed as a day case in hospital and operating theatres.
The local anaesthetic component of the injection blocks the pain receptors in the hip with the aim of absolving both acute and chronic pain. The cortisone is the body’s own inflammatory and over a period of six weeks reduces inflammation and pain in the hip.
Normally an hour after the procedure the patient can be got up and start to walk. The patient can go home the same day but a friend or relative should stay with the patient overnight. Driving or operating machinery is not recommended for 24 hours after the injection.
I recommend reduced activity for 24 hours. This means the patient can do normal activities of daily living including walking but no sports or long walks. The patient can then gradually return to activity as comfortable. It should be noted that although some patients get immediate relief of their symptoms the injections can take up to six weeks to fully work. At this stage Mr Middleton reviews the patient in the Out Patient Clinic.
The procedure is safe. The anaesthetic is short and the risks from this are very small, the operation is performed in theatre to reduce the risk of infection. The main side effect is that one in thirty patients, usually women, can get some facial flushing the day after the injection but this resolves spontaneously. The injection is not a cure for arthritis but can often give relief of the symptoms and delay the need for hip replacement surgery. In severe arthritis it often has little effect and I normally recommend the patient goes straight for a hip replacement.
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