Corticosteroid injections are the most widely recommended and evidence-backed injection for hip pain, particularly from osteoarthritis. They offer reliable short-term relief, with about 75% of patients experiencing meaningful pain reduction within the first month. But “best” depends on your specific situation: how severe your pain is, what’s causing it, and whether you need quick relief or longer-lasting results. Several injection types are available, each with different strengths and tradeoffs.
Corticosteroid Injections: The Standard Option
Corticosteroids are the go-to hip injection and the only type that carries a formal recommendation from the American Academy of Orthopaedic Surgeons (AAOS) for hip osteoarthritis. The recommendation is based on high-quality evidence showing they reduce pain and improve function in the short term.
The relief typically peaks within the first few weeks and lasts up to about 12 weeks. In clinical trials, roughly two-thirds of patients met established criteria for a meaningful response at 8 weeks, compared to less than a quarter of those who received a placebo. By 3 months, though, only about one in three patients still reported a strong response. This makes corticosteroids best suited for acute flare-ups, bridging the gap before surgery, or situations where you need to function better for a defined period.
One important safety concern: a 2023 meta-analysis found that roughly 6% of patients who receive corticosteroid hip injections develop rapidly progressive osteoarthritis, a condition where cartilage breaks down faster than expected. This doesn’t mean corticosteroids cause joint damage in most people, but it does mean repeated injections over time carry real risk. Most providers limit steroid injections to three or four per year in the same joint.
Platelet-Rich Plasma (PRP): Longer Relief, Less Certainty
PRP injections use a concentrated sample of your own blood platelets, which contain growth factors that promote tissue repair and reduce inflammation. The appeal of PRP is durability. In studies comparing PRP to corticosteroids for joint arthritis, the steroid injection tends to work faster, but PRP catches up by around 3 months and pulls ahead by 12 months. One randomized trial found that at the one-year mark, 62.5% of PRP patients reported only mild pain, compared to just 12.5% in the steroid group. Patient satisfaction followed a similar pattern: 69% versus 12.5% at 12 months.
The catch is that most of this comparative research comes from joints other than the hip, and PRP protocols vary widely between clinics. The concentration of platelets, the number of injections, and the preparation method all differ, making it hard to standardize results. PRP is also not covered by most insurance plans, so you can expect to pay several hundred dollars out of pocket per injection. For people with mild to moderate hip arthritis who want to avoid or delay surgery, PRP is a reasonable option to discuss with your provider.
Hyaluronic Acid: Mixed Evidence for Hips
Hyaluronic acid injections (sometimes called viscosupplementation) work by restoring the lubricating and shock-absorbing properties of the fluid inside your joint. They’ve been used widely in knees for years, and some real-world data shows benefits in the hip as well. One clinical follow-up study found that a single injection led to a 25% reduction in pain scores and roughly 12% improvement in physical function at 6 months.
Despite those findings, the AAOS explicitly recommends against hyaluronic acid for hip osteoarthritis, with a strong recommendation based on high-quality evidence. Their conclusion: it doesn’t outperform placebo in controlled trials. The gap between real-world observations and randomized trial results may reflect placebo effects, patient selection, or differences in the products used. If you’re considering this option, it’s worth knowing that the major orthopedic guidelines currently don’t support it for the hip, even though individual clinicians may still offer it.
Bone Marrow Aspirate Concentrate (BMAC)
BMAC injections are a form of regenerative medicine that uses stem cells and growth factors harvested from your own bone marrow, typically drawn from the pelvis. The idea is to promote cartilage repair and reduce inflammation at the cellular level. Early results are encouraging. A systematic review of five studies covering 182 patients found that BMAC consistently reduced pain and improved function, with no reported adverse events.
In one study, pain scores during activity dropped from 8 out of 10 to 4.5 out of 10 over six months, and patients maintained those gains without reverting to their pre-procedure levels. Another found that patients reported an average overall improvement of 72.4% in both resting and active pain. Peak improvements generally appeared between 3 and 6 months after the injection, and results did not depend on the patient’s age, sex, or severity of arthritis on imaging.
The limitations are significant, though. The total body of evidence is still small, no large randomized controlled trials exist yet for hip-specific use, and the procedure costs considerably more than a steroid injection. BMAC is typically not covered by insurance.
Cooled Radiofrequency Ablation: A Different Approach
This isn’t a traditional “injection” in the way most people think of one, but it’s performed with a needle and increasingly offered alongside injection options. Cooled radiofrequency ablation uses heat delivered through a needle tip to disable the sensory nerves around the hip joint, blocking pain signals. It doesn’t treat the underlying joint damage, but it can provide meaningful relief for people who aren’t surgical candidates or who want to postpone a hip replacement.
In a study of patients with avascular necrosis (a condition where bone tissue dies from poor blood supply), pain scores dropped substantially after the procedure, and five out of seven patients reported more than 50% pain relief lasting anywhere from 70 to 250 days. This option works best for people who responded well to a diagnostic nerve block, which your provider would typically perform first to confirm you’re a good candidate.
Why Imaging Guidance Matters
The hip is a deep joint surrounded by thick muscle and tissue, which makes accurate needle placement harder than in a knee or shoulder. How the injection is guided has a major impact on whether the medication actually reaches the joint space. Ultrasound-guided injections are accurate more than 95% of the time. Injections guided only by anatomical landmarks (essentially, the provider’s feel for where the joint is) land correctly about 60% to 70% of the time in most studies, with a pooled accuracy around 81%. Ultrasound guidance is roughly five times more likely to hit the target.
If your provider offers the choice, ultrasound or fluoroscopy (a type of real-time X-ray) will give you the best chance of a successful injection. This matters regardless of which injection type you choose, because even the best medication won’t help if it ends up in the surrounding tissue instead of the joint.
Who Should Avoid Hip Injections
Certain conditions rule out hip injections entirely. You should not receive any intra-articular injection if you have an active joint infection, a skin infection near the injection site, an active bloodstream infection, or a known allergy to the substance being injected. An acute fracture in or around the hip is also a contraindication.
Beyond those absolute restrictions, your provider will weigh factors like how many steroid injections you’ve already had this year, whether you’re on blood thinners, and whether you’re planning a hip replacement in the near future (steroid injections too close to surgery may increase infection risk). People with diabetes should also be aware that corticosteroid injections can temporarily raise blood sugar levels for several days after the procedure.
Choosing the Right Injection for You
For fast, reliable, insurance-covered relief that lasts a few months, corticosteroids remain the strongest option. If you’re looking for something that may last longer and you’re willing to pay out of pocket, PRP has the most promising comparative data, with better outcomes than steroids at the one-year mark. BMAC offers another regenerative option with encouraging early results, but the evidence base is still thin and the cost is high. Hyaluronic acid, despite its popularity for knees, doesn’t have guideline support for hips.
The severity of your arthritis also plays a role. People with mild to moderate joint damage tend to respond better to regenerative options like PRP and BMAC. Those with advanced, bone-on-bone arthritis may get temporary relief from any injection, but the realistic next step is often a joint replacement. In that scenario, a corticosteroid injection can serve as a useful bridge to keep you functional while you prepare for surgery.