Hyaluronic acid is a natural component of synovial fluid and contributes to its lubricating properties. During treatment, a hyaluronic acid preparation is introduced directly into the hip joint with a fine needle.

The treatment is one of the various forms of hyaluronic acid therapy. Because the hip joint lies relatively deep, the position of the needle can be monitored using ultrasound or X-ray.

A hyaluronic acid injection can be considered for selected patients with degenerative conditions of the hip joint, particularly for:

• Hip osteoarthritis (coxarthrosis);
• activity-related pain in the hip joint;
• limited mobility;
• recurrent symptoms despite conservative treatment;
• intolerance or insufficient effect of other treatments.

Not all pain in the hip area originates directly in the hip joint. Muscles, tendons, bursae, the lumbar spine, or the sacroiliac joint can also cause symptoms. Therefore, the likely source of pain must first be identified before an injection.

Further information on causes, symptoms, and treatment options can be found on our page on hip osteoarthritis

The scientific assessment of hyaluronic acid therapy for hip osteoarthritis is reserved. The current guideline of the American Academy of Orthopaedic Surgeons does not recommend intra-articular hyaluronic acid as a routine treatment for symptomatic hip osteoarthritis, because compared with a placebo injection no sufficient improvement in pain or joint function has been demonstrated.

A specific effect or duration of effect therefore cannot be assured. Whether the treatment is nevertheless discussed in an individual case requires detailed medical counseling about possible alternatives.

Medical examination

First, the symptoms, their duration, and prior treatments are discussed. The physician examines the hip and assesses any existing X-ray, ultrasound, or MRI findings.

Preparation

The treatment area is carefully disinfected. The appropriate injection site is then determined.

Image-guided injection

Due to the deep location of the hip joint, the needle can be guided to the intended position under ultrasound or X-ray guidance. The hyaluronic acid preparation is then injected into the joint.

Further information on the controlled placement of an injection can be found on the page about ultrasound-guided pain therapy. The hip joint is explicitly mentioned there as a possible area of application.

Follow-up

After the treatment, the immediate reaction is monitored. You will then receive individualized recommendations regarding weight-bearing on the hip and the further treatment plan.

The number and intervals of treatments depend on the preparation used. Depending on the product, a single injection or a series of treatments may be planned.

Whether further treatment is advisable is assessed based on the effect to date, tolerability, and individual findings.

In particular, inform the treating physician about:

• acute infections or fever;
• skin changes in the area of the injection site;
• allergies to medications or components of the preparation;
• blood clotting disorders;
• blood-thinning medications;
• pregnancy;
• medications taken regularly.

Medications must not be discontinued or changed before the treatment without prior consultation with a physician.

After the treatment, it may be advisable to temporarily rest the hip. Intense sports activities and longer walking distances should initially be avoided in accordance with the doctor's recommendation.

Temporary pain or a feeling of pressure at the injection site may occur. In the event of increasing pain, pronounced swelling, marked redness, increased warmth, or fever, the practice should be contacted.

A hyaluronic acid injection does not eliminate the underlying changes of the hip joint. The treatment should therefore not be considered in isolation.

Depending on the findings, an individual treatment plan may include, among other things, the following measures:

• Physiotherapy and therapeutic exercises;
• Strengthening of the hip and gluteal muscles;
• Adjustment of physical load;
• Weight reduction where indicated;
• Medication-based treatment;
• Other forms of infiltration of the hip;
• Surgical evaluation in advanced osteoarthritis.

An overview of the various conservative, interventional, and surgical options can be found on our page on osteoarthritis therapy.