Bi-lateral Hip Pain - Prolotherapy and
Steroid Injection
Ross Hauser, M.D.

First let me start by saying, most people who know me and have read some of the articles I have written know that I am not a big fan of giving injections under X-ray.

Here are a few of my objections to performing injections under X-ray:

1. No study anywhere in the world that I know of reports that injections under X-ray actually give better results compared to injections given without X-ray guidance.

2. Insurance companies pay billions of dollars for these injections under X-ray, yet no documentation exists showing improvement in patient care.

3. Steroids are the typical solutions physicians use for these injections under X-ray (called fluoroscopic guidance)yet steroids have been shown to cause cartilage deterioration.

4. Injections under X-ray guidance cost 10 times the amount as normal Prolotherapy injections.

5. Only one injection is typically given when performed under fluoroscopic guidance, so what is the likelihood that the injection is going to give long-term pain relief? I would say the answer to that is “very low.”

If you don’t agree with the above, let’s look at one example from a patient who was just here at the office last week:

Mark came into the clinic with a two year history of bilateral hip pain, right hip worse than the left. The pain started two years ago during a run. Mark typically ran 28-30 miles per week, but had not run for about two years, since the hip pain started. As a 51-year-old, he was getting pretty discouraged because he had tried physiotherapy, chiropractic care, electrical stimulation, laser treatments, and all the recommendations given to him pointed him toward bilateral hip replacement. The last treatment he tried was a fluoroscopically guided steroid injection into his severely degenerated hip. The net result was almost no pain relief and an expense of $2700.

I hope to provide you with documentation of what I am saying so you will know beyond a shadow of a doubt that what I am saying is true. These are real patients with real stories. I know most of you believe me, but for the skeptics, you will see more real arthroscopy reports, X-ray reports, and invoices from other providers.

Back to Mark. He received a steroid injection under X-ray guidance at some would say is one of the best medical centers for sports medicine care. In other words, Mark received the best of traditional medical care and I am saying it was ridiculous, ludicrous, and consciously unethical to perform an almost $3000 steroid shot on a person with bone on bone osteoarthritis.

This steroid shot was absolutely not indicated and should not have been performed. Another interesting part of his medical chart was the Pain Diary that he completed post-steroid injection.
He reported a 7/10 pain level prior to the injection.

In the hours post-procedure, this is what happened:
1 hour = 0/10;
2 hours= 2/10;
3 hours=4/10;
4 hours=4/10;
5 hours=7/10;
6 hours=8/10.
You can interpret that for yourself!

Please see his X-ray report below:
Examination: Xray Hip (RIGHT)
Perf: 3/19/2009 10:35:00 AM

Indication: Right hip pain
Impression: Moderate changes of osteoarthritis, with joint space narrowing, subchondral sclerosis, subchondral cysts and marginal osteophytes are noted in the right and left hip, right greater than left. Otherwise, no abnormalities are identified. There is evidence of fracture dislocation.

From the above report, Mark basically has extensive osteoarthritis, with the right hip worse than the left hip. On my physical examination with his hip flexed 90 degrees, he only had 17 degrees of external rotation on his left hip and even less on his right (less than 10 degrees). In other words, this is extremely bad osteoarthritis. The only treatment that can keep someone from a hip replacement is Prolotherapy. But I first want you to hear some more about the treatment that Mark had received prior to coming in to see me.

Mark brought some of his medical records with accompanying billing for me to review at his initial consultation. You can clearly see the following charges: initial consultation and the initial steroid shot: $2689.00 of which he had to pay $2019.60 out of pocket.

In my opinion, this was a total waste of money, not to mention a treatment that would worsen his condition. I believe that the science of steroids on cartilage is that steroids degenerate it, while Prolotherapy regenerates it. Articular cartilage see also Articular Cartilage Growth (see research paper).

At Caring Medical, Mark received a $330.00 Prolotherapy treatment to his right hip and the procedure went well. We received this email from Mark in response to our post-Prolotherapy follow-up call:

Hello Dr. Hauser,
Just a few lines regarding the 1st treatment. You and your staff are a pleasure to interact with. The injections were not without pain, however, after a few hours the injection pains subsided and to my pleasant surprise, my hip pain also was reduced. The mobility of the hip was noticeably improved and I am looking forward to my next treatment. Thank you. M.K.

You might be thinking, “How could the mobility in his hip be better one day after Prolotherapy?” The answer: it provided pain relief! With less pain, you obviously are able to more freely move your joints! What will be Mark’s ultimate outcome? While I cannot predict the future, there is a good chance he will get out of pain. Whether he will run again is yet to be determined, but I am sure he will be an avid cyclist!

The bottom line here is that Prolotherapy has a chance to get him better – I would give it a 90% chance. Steroids have a 0% chance to get him better. In the end, Prolotherapy costs a fraction of what a steroid shot costs. In my mind, there is no competition. Prolotherapy for degenerative arthritis is the most effective and least costly treatment option available!