Hip Injections: Inside the Joint vs. the Side of the Hip

When a patient asks me about a hip injection, my first question is: where does it hurt? “Hip pain” can mean pain deep in the groin or pain on the outside of the hip, and they usually come from different places. I do two different injections for them.

Two types of hip pain, two types of injection

• Pain on the side of the hip, over the bony point, often worse lying on that side: this usually comes from the bursa and the abductor muscles. The injection goes into the side of the hip.
• Pain in the groin or the front of the hip, often with stiffness putting on shoes and socks: this usually comes from inside the joint, most often arthritis. The injection goes into the joint, under ultrasound.

Many patients have some of both, which is why an exam and X-rays come first.

The side-of-the-hip (bursa) injection

This is often called a lateral hip injection or a bursa injection. Here’s why the side of the hip hurts in so many people with hip problems.

When the hip joint is damaged, by arthritis, a labral tear, acetabular impingement (FAI), or hip dysplasia, the muscles around it work overtime to protect it. The abductors, the muscles on the side of your hip, take much of that load. Over time they and the bursa next to them become inflamed and painful. Labral tears are very common in hips with arthritis, so I see this pattern all the time.

For that pain, I inject cortisone or PRP into the bursa on the side of the hip. You can read more about this kind of pain in hip bursitis.

The ultrasound-guided hip joint injection

The hip joint sits deep, under a lot of muscle, so I don’t inject it blind. This is called an intra-articular hip injection, meaning inside the joint:

1. I use a large ultrasound probe to find the hip socket on the screen.
2. While watching on ultrasound, I guide a spinal needle, which is long and thin, into the joint.
3. I inject cortisone or PRP directly where the arthritis is.

It’s done right in my office. The ultrasound lets me see that the medicine is going where it needs to go.

Cortisone or PRP?

Either injection, side of the hip or inside the joint, can be done with cortisone or PRP.

• Cortisone calms inflammation and works within days. Relief lasts 3 to 6 months on average. It’s usually covered by insurance.
• PRP (platelet-rich plasma) uses a concentrate of your own blood. Relief builds gradually, over weeks, and in the right patient it often lasts longer. For the hip, I still recommend a 2-shot series. PRP isn’t covered by insurance.

What about gel? I use gel (hyaluronic acid) in the knee only. For the hip, it’s cortisone or PRP. For a side-by-side comparison, see cortisone vs. gel vs. PRP.

Why I never do both at the same visit

If your pain could be coming from the side of the hip or from inside the joint, it’s tempting to do both at once. I don’t. If both were injected on the same day and you felt better, we wouldn’t know which one helped.

One injection at a time tells us where your pain is really coming from, and that answer guides everything after it, including whether a hip replacement would fix the pain.

The 3-month rules

• Between injections: I won’t do another hip injection within 3 months of the last one.
• Before surgery: if you’re heading toward a hip replacement or other hip surgery, I usually wait at least 3 months after an injection, in the joint or on the side of the hip, before operating. More on why in cortisone injections before joint replacement.

If injections stop lasting 3 months, or your hip is bone-on-bone, that’s the time to talk about whether it’s time for a replacement. See the signs you need a hip replacement.

Which injection do you need?

That depends on where your pain is, what your exam shows, and what your X-rays show. In one visit, I can usually tell you whether the pain is coming from the side of the hip or from inside the joint, which injection makes sense, and whether cortisone or PRP is the better fit for you.

This article is general education. It isn’t advice about your specific hip.