Gel Injections for Hip Arthritis: What You Need to Know

Key Takeaways

Gel injections can work for hip arthritis - the same hyaluronic acid products used for knees may provide relief for hip osteoarthritis
Imaging guidance is mandatory for hip - unlike knees, hip injections absolutely require fluoroscopy or ultrasound due to the joint’s depth
Evidence is more limited than for knees - fewer studies exist, but available research shows promising results
Results typically last 3-6 months - similar to or slightly shorter than knee injection duration
Medicare coverage may be more limited - hip viscosupplementation is often considered off-label, affecting insurance approval

Hip Arthritis and Your Treatment Options

If you’re living with hip arthritis, you know the challenges. Deep groin pain when you walk. Stiffness when you get out of bed. Difficulty putting on your shoes or getting in and out of a car. These symptoms affect millions of Americans, and finding effective relief becomes a priority.

Hip osteoarthritis affects approximately 10 million Americans. The traditional treatment ladder goes from physical therapy to medications to cortisone injections, eventually leading to hip replacement surgery for many people. But there’s a treatment option that doesn’t get discussed as often for hips: gel injections, also known as hyaluronic acid (HA) injections or viscosupplementation.

If you’ve researched gel injections, you’ve probably noticed most information focuses on knees. That’s because knee osteoarthritis is more common and FDA approval is specifically for knee treatment. However, the same principles that make gel injections work for knees apply to hips - restoring joint lubrication and cushioning to reduce pain and improve function.

This guide explains what you need to know about gel injections specifically for hip arthritis, including how they differ from knee injections and what the research actually shows.

How Gel Injections Work for Hip Pain

The Science Behind Viscosupplementation

Your hip joint contains a natural lubricant called synovial fluid. Think of it like motor oil in an engine. Healthy synovial fluid is thick and slippery, allowing the ball of your thigh bone (femoral head) to glide smoothly in its socket (acetabulum).

With osteoarthritis, this fluid becomes thinner and less effective. The cartilage surfaces that should glide effortlessly start to grind against each other. This causes inflammation, pain, and further damage.

Gel injections deliver hyaluronic acid directly into the joint. Hyaluronic acid is a natural substance your body produces - it’s the main component of healthy synovial fluid. The injected gel:

Restores Lubrication

Supplements the thinned synovial fluid with thick, cushioning gel that helps joint surfaces move more freely.

Reduces Friction

The gel coating reduces bone-on-bone contact, which decreases pain with movement and weight-bearing activities.

May Reduce Inflammation

Research suggests HA has anti-inflammatory properties that may help calm irritated joint tissues.

Provides Longer Relief

Unlike cortisone shots that wear off in weeks, gel injections may provide relief lasting 3-6 months or longer.

How It Differs from Cortisone

Cortisone (corticosteroid) injections work by reducing inflammation quickly. They can provide dramatic short-term relief but wear off relatively fast and have limits on how often they can be given due to potential side effects on cartilage.

Gel injections work differently. They don’t mask inflammation - they supplement the joint’s natural lubrication system. While they take longer to show results (typically 2-4 weeks), the relief often lasts longer and can be repeated when needed without the same concerns about cartilage damage.

Why Hip Injections Are Different from Knee Injections

This is crucial information that many patients don’t receive: hip injections are fundamentally different from knee injections in terms of technique and requirements.

The Depth Challenge

Critical Difference

Your knee joint sits just below the skin surface. Your hip joint is buried 3-4 inches deep in your body, surrounded by muscle, fat, nerves, and blood vessels.

A skilled provider can often accurately inject a knee using only physical landmarks. The same is not true for hips.

The hip joint is one of the deepest joints in the body. Here’s why this matters:

Factor	Knee Joint	Hip Joint
Depth from skin	1-2 cm	8-12 cm (3-5 inches)
Blind injection accuracy	70-80%	Very low - often misses
Imaging required	Recommended but optional	Absolutely mandatory
Surrounding structures	Relatively few obstacles	Major nerves, arteries, muscles

The Anatomy Issue

The hip joint is accessed through a narrow window. The femoral nerve and artery run nearby. Surrounding muscles are thick. Without real-time visualization, a provider is essentially guessing where the joint space is.

Studies consistently show that blind hip injections (using landmarks alone without imaging) miss the joint space a significant percentage of the time. When the medication doesn’t reach the joint, it can’t provide relief.

Bottom line: If a provider offers to inject your hip without imaging guidance, consider finding a different provider.

The Critical Importance of Imaging Guidance

Why Imaging Is Mandatory for Hip

For hip injections, imaging guidance isn’t a luxury or “best practice” - it’s a necessity. The research is clear:

Blind hip injections frequently miss the joint entirely
Imaging-guided injections achieve near-100% accuracy
Outcomes are significantly better when the medication reaches the intended target

Think about it this way: Would you pay for a treatment that has a substantial chance of being delivered to the wrong place? Imaging guidance eliminates this risk.

Fluoroscopy vs. Ultrasound for Hip Injections

Two imaging methods are used for hip injections. Both dramatically outperform blind technique.

Fluoroscopy (X-Ray Guidance)

How it works: Continuous X-ray imaging shows bone structures in real-time. Contrast dye can confirm the needle is inside the joint.

Advantages:

100% accuracy rate
Clear visualization of hip joint space
Contrast dye provides definitive confirmation
Excellent for deep structures like the hip
Gold standard for hip injections

Considerations:

Small radiation exposure (equivalent to a few hours of background radiation)
Requires specialized equipment
Typically performed in interventional settings

Ultrasound Guidance

How it works: Sound waves create real-time images of soft tissue and the needle path.

Advantages:

No radiation exposure
Excellent soft tissue visualization
More portable equipment
Real-time needle tracking

Considerations:

Operator skill significantly affects accuracy
Hip depth can make imaging challenging in some patients
Cannot use contrast dye to confirm placement

For hip injections specifically, many experts consider fluoroscopy the gold standard because:

The hip’s depth makes it challenging to visualize with ultrasound in some patients
Contrast dye confirmation is particularly valuable for this deep joint
Bony landmarks are clearly visible under X-ray

However, ultrasound in experienced hands can be highly effective. The key is ensuring your provider uses some form of imaging guidance - not whether they use fluoroscopy vs. ultrasound.

Learn more about why imaging guidance matters for all joint injections in our detailed guide: The Precision Problem: Why Injection Accuracy Matters.

What the Research Shows

The Evidence Picture for Hip HA Injections

Here’s an honest assessment: the evidence base for hip viscosupplementation is smaller than for knee viscosupplementation. This doesn’t mean hip injections don’t work - it means fewer large studies have been conducted.

Why the difference?

Knee OA is more common - more patients means more research opportunities
FDA approval is for knees - pharmaceutical companies focused clinical trials on knees
Hip injections are technically harder - requires imaging, limiting study sites

What Available Studies Show

Despite the smaller evidence base, published research on hip viscosupplementation shows encouraging results:

Key Findings from Hip HA Studies:

Outcome Measured	Typical Result
Pain reduction	Significant improvement vs. baseline
Function improvement	Better walking, stair climbing, daily activities
Duration of effect	3-6 months in responders
Safety profile	Good - similar to knee injections
Patient satisfaction	Generally positive in responders

What the Research Tells Us

Studies examining HA injections for hip osteoarthritis have found:

Pain scores improved significantly compared to baseline in most patients
Functional outcomes improved - patients reported easier walking and daily activities
Effects lasted several months in those who responded
Safety was comparable to knee injections - no serious adverse events specific to hip use
Some patients achieved meaningful delay in considering hip replacement

The Honest Assessment

What we know:

Hip HA injections work for many patients
The mechanism (lubricating the joint) is the same as for knees
When accurately placed, outcomes are promising
Safety profile is established and favorable

What we need more of:

Large randomized controlled trials specific to hip
Long-term follow-up data
Better prediction of which patients respond best

The reality is that hip viscosupplementation is supported by clinical experience and smaller studies, even if the massive evidence base that exists for knees isn’t yet available for hips.

What to Expect During a Hip Injection

Understanding the procedure helps reduce anxiety and ensures you’re prepared.

Before Your Appointment

Arrive in comfortable, loose-fitting clothing - you’ll need to expose your hip area
Inform your provider of blood thinners, allergies, or infections
Bring your imaging (X-rays or MRI) if not already on file
Plan for 30-45 minutes including imaging setup

The Injection Process

Step-by-Step: Hip HA Injection with Fluoroscopy

1. Positioning You’ll lie on your back on the procedure table. The hip area is cleaned with antiseptic solution.

2. Imaging Setup The fluoroscopy machine is positioned to visualize your hip joint. You’ll see the ball-and-socket joint on the screen.

3. Local Anesthesia The skin and deeper tissues are numbed with lidocaine. You may feel a brief sting, then the area becomes numb.

4. Needle Placement Under real-time X-ray guidance, the provider advances a needle toward your hip joint. You’ll see this on the screen.

5. Contrast Confirmation (fluoroscopy) A small amount of contrast dye is injected. If the needle is in the joint, the dye outlines the joint space on X-ray - this is your visual proof of accurate placement.

6. HA Injection Once position is confirmed, the hyaluronic acid gel is slowly injected into the joint space.

7. Completion The needle is removed, and a small bandage is applied.

The Two Main Approaches for Hip Injections

Providers access the hip joint using one of two main approaches:

Anterior approach: Needle enters from the front of the hip
Lateral approach: Needle enters from the side

Both are effective when performed with imaging guidance. Your provider will choose based on your anatomy and their training.

What Most Patients Feel

During numbing: Brief sting, then numbness
During needle advancement: Pressure sensation (most report minimal discomfort)
During injection: Feeling of fullness in the hip
Overall: Most patients describe the procedure as easier than expected

How Long Do Results Last?

Typical Duration for Hip Injections

Expected timeline for hip viscosupplementation:

Timeframe	What to Expect
Days 1-3	Possible mild soreness at injection site
Week 1-2	Some patients notice early improvement; others still waiting
Week 3-4	Pain relief typically becomes noticeable
Week 6-8	Maximum benefit usually achieved
Months 3-6	Sustained relief in responders
Month 6+	May consider repeat injection if initial treatment worked

Hip vs. Knee Duration

Hip injection results may be somewhat shorter than knee results in some patients. Possible reasons include:

Higher forces on the hip - the hip bears more of your body weight
Constant motion - the hip moves with every step
Deeper joint - gel may distribute differently

That said, many patients report 3-6 months of meaningful relief, which is comparable to knee injection duration.

Factors Affecting How Long Relief Lasts

Your results depend on several factors:

Arthritis severity: Earlier stages tend to respond longer than severe bone-on-bone disease

Activity level: Moderate activity is better than both inactivity and high-impact stress

Body weight: Less weight means less stress on the hip joint

Injection accuracy: Imaging-guided placement ensures the gel reaches the joint

Individual response: Some people simply respond better than others

Medicare and Insurance Coverage

The Coverage Challenge for Hip Injections

Here’s an important reality: insurance coverage for hip viscosupplementation may be more limited than for knee injections.

Important Distinction

FDA-approved hyaluronic acid products are labeled for knee osteoarthritis. When used in the hip, this is considered “off-label” use - the same products, but for an indication not on the FDA label.

Off-label doesn’t mean unsafe or improper. It means the FDA approval process focused on knees. About 20% of all prescriptions in the U.S. are for off-label uses.

However, insurance companies may use the off-label status to limit or deny coverage.

Medicare Coverage Details

Traditional Medicare (Part B):

Covers FDA-approved HA injections for knee osteoarthritis
Hip coverage is determined on a case-by-case basis
Medical necessity documentation is critical
Some Medicare Administrative Contractors (MACs) have specific policies

Medicare Advantage:

Policies vary by plan
May have different coverage criteria than Original Medicare
Prior authorization is commonly required
Some plans explicitly exclude off-label joint injections

How to Maximize Your Chances of Coverage

If you want to pursue hip HA injections with insurance coverage:

Ask your provider’s billing office to verify coverage before the procedure
Document failed conservative treatments - PT, medications, activity modification
Obtain X-rays showing hip arthritis - objective evidence of the condition
Request prior authorization if required by your plan
Have your doctor document medical necessity clearly in your records

If Coverage Is Denied

Options when insurance denies hip HA injections:

Appeal the decision with a letter of medical necessity and supporting research
Peer-to-peer review - your doctor speaks directly with the insurance medical director
Self-pay pricing - some clinics offer cash-pay rates for this treatment
Ask about payment plans if paying out of pocket

Is a Hip Injection Right for You?

Good Candidates for Hip Viscosupplementation

Mild to moderate hip osteoarthritis - confirmed by X-ray showing cartilage loss but not complete bone-on-bone contact throughout the joint

Failed conservative treatments - physical therapy, NSAIDs, and activity modification haven’t provided adequate relief

Looking to delay hip replacement - want to buy time before considering surgery

Concerned about cortisone limitations - want an alternative to repeated steroid injections

Not surgical candidates - health conditions that make hip replacement risky

Less Ideal Candidates

Severe end-stage hip arthritis - bone-on-bone throughout the joint may not respond well
Active hip infection - must be treated before any injection
Allergy to HA or avian products - applies to chicken-derived HA products
Unrealistic expectations - HA won’t regenerate cartilage or “cure” arthritis
Inflammatory arthritis - rheumatoid arthritis may respond differently than osteoarthritis

Questions to Ask Yourself

Before pursuing hip viscosupplementation, consider:

How much is hip pain affecting my daily life?
Have I tried and given adequate time to physical therapy?
Am I looking to delay hip replacement or simply want better pain control?
Am I prepared if insurance doesn’t cover the treatment?
Do I have access to a provider who uses imaging guidance?

Finding the Right Provider

Essential Requirements for Hip Injections

Non-Negotiable: Imaging Guidance

Any provider performing hip injections must use imaging guidance. If a provider offers to inject your hip using landmarks alone (blind technique), find someone else.

Ask specifically: “Do you use fluoroscopy or ultrasound guidance for hip injections?”

Provider Types Who Perform Hip Injections

Interventional pain management physicians - hip injections are a core part of their practice
Sports medicine specialists - particularly those trained in musculoskeletal procedures
Interventional radiologists - imaging is their specialty
Some orthopedic surgeons - especially those focused on non-surgical management

Questions to Ask Before Scheduling

“How many hip HA injections have you performed?” - Look for experience
“What imaging guidance do you use?” - Fluoroscopy or ultrasound
“Do you use contrast dye to confirm placement?” - Standard with fluoroscopy
“Which HA product do you prefer for hips?” - Shows thoughtfulness about the procedure
“What outcomes have your hip patients typically experienced?” - Realistic expectations

Red Flags to Watch For

Be cautious if:

Provider doesn’t mention imaging guidance
No experience specifically with hip (as opposed to knee) injections
Guarantees specific outcomes or duration
Dismisses questions about technique
Unusually rushed consultation

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The Bottom Line

Summary

Gel injections for hip arthritis represent a reasonable treatment option for many patients, even though the evidence base is smaller than for knees and insurance coverage may be more limited.

What makes hip injections different:

Imaging guidance is absolutely mandatory (not optional)
The evidence base is still building but promising
Insurance coverage requires more navigation
Results typically last 3-6 months

What makes hip injections similar to knee:

The same mechanism of action (restoring lubrication)
Same products used
Similar safety profile
Potential to delay or avoid joint replacement

If hip arthritis is limiting your mobility and quality of life, and you’ve exhausted conservative options, gel injections deserve consideration as part of your treatment discussion - provided you can find a provider who uses proper imaging guidance.

Frequently Asked Questions

Are gel injections FDA-approved for hip arthritis?

FDA approval is specifically for knee osteoarthritis. Hip use is considered “off-label” - meaning it’s a medically accepted use of an approved product, just not the labeled indication. This is common in medicine (about 20% of prescriptions are off-label) and doesn’t indicate the treatment is unsafe or experimental.

Will my insurance cover hip gel injections?

Coverage varies significantly. Medicare covers knee HA injections but hip coverage is determined case-by-case. Private insurance policies differ in their approach to off-label treatments. Always verify coverage with your provider’s billing office before the procedure. Having documentation of failed conservative treatments improves approval chances.

Can a hip injection be done without imaging?

It should not be. The hip joint is too deep (3-5 inches below the skin surface) to access accurately without imaging guidance. Blind hip injections have unacceptably high miss rates. Always ensure your provider uses fluoroscopy or ultrasound guidance for hip injections.

How many injections will I need?

Protocols vary by product. Some HA products (like Synvisc-One or Durolane) are designed as single-injection treatments. Others may use a series of 3-5 weekly injections. Your provider will recommend based on the product chosen and your response. Many patients benefit from repeat treatment every 6-12 months if the initial injection was effective.

Is the injection painful?

Most patients report the procedure is more comfortable than expected. Local anesthetic numbs the area before the injection. You may feel pressure or a sensation of fullness as the gel is injected. Post-procedure soreness is common for 1-2 days but typically mild. Ice and over-the-counter pain relievers help if needed.

What if the injection doesn’t work?

Not everyone responds to viscosupplementation. If you don’t get adequate relief, options include trying a different HA product, continuing physical therapy, different injection types (PRP), or discussing surgical options. One non-response doesn’t mean you’re out of options - it means you need to explore alternatives with your provider.

Can I have gel injections if I’ve had cortisone shots?

Yes. Many patients have received cortisone injections before trying HA. The two treatments work differently and can both be part of your overall management plan. There’s typically a waiting period (a few weeks) between different injection types. Discuss timing with your provider.

Will gel injections prevent me from needing hip replacement?

Gel injections may delay the need for hip replacement by managing symptoms and maintaining function. However, they don’t reverse arthritis or regenerate cartilage. For some patients, they provide years of meaningful relief before surgery becomes necessary. For others, they offer months of improved quality of life. They’re best viewed as one tool in your treatment toolbox, not a permanent solution.

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Last medically reviewed: January 24, 2026

Disclaimer: This article is for informational purposes only and does not replace professional medical advice. Always consult with a qualified healthcare provider about treatment options for your specific condition.