Hip embolization

Two common causes of hip pain in adults are osteoarthritis, the wear-and-tear arthritis that thins the cartilage in the hip joint, and tendinopathy, long-term irritation of the tendons on the outside of the hip. Tendon pain on the side of the hip is often called greater trochanteric pain syndrome, and it used to be called hip bursitis.

In both conditions, the painful tissue is often inflamed. The body grows extra tiny blood vessels into the irritated area, and small pain nerves grow alongside them. These vessels keep the inflammation going and are thought to be one source of the pain.

Transarterial embolization for hip pain uses the same idea as genicular artery embolization for the knee. An interventional radiologist, a doctor who uses X-ray to guide thin tubes through the blood vessels, finds the small arteries feeding the inflamed areas around the hip and places tiny particles in them. The goal is to calm the inflammation and reduce pain, while the normal blood supply to the hip is kept.

Hip embolization is newer than knee embolization. So far, it has been studied in small groups of patients, often without a comparison group, and usually followed for a year or less. In these early studies, many people reported less pain and better function, and serious complications were rare.

What we do not yet know is how well it works compared with a placebo procedure, exactly who benefits most, and how long relief lasts. Larger, controlled trials are needed. For these reasons, we offer hip embolization only after a careful discussion, usually when standard treatments have not helped and surgery is not a good fit or not wanted yet.

I tell patients plainly that hip embolization is promising but still early. When I review the MRI, I look for signs of active inflammation around the joint or the tendons, because that is what embolization targets. If the pain is really coming from the spine or from a hip that needs replacing, I would rather say so and point them to the treatment that is most likely to help.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Physical therapy and strengthening, weight loss if needed, and anti-inflammatory medicines are the first steps for most hip pain. Steroid injections into the joint or around the tendons can give relief for weeks to months. For advanced arthritis, hip replacement is a very effective and well-proven operation.

Embolization does not rebuild cartilage or stop arthritis from progressing. It does not prevent a future hip replacement.

The procedure is done at El Camino Hospital as an outpatient. Do not eat for about 8 hours before, and bring an adult to drive you home. See before your procedure and sedation.

1. 1
   Getting ready

   A nurse places an IV and you are connected to heart, blood pressure and oxygen monitors. You receive moderate sedation so you are relaxed and comfortable.

2. 2
   A pinhole and a map

   The skin over an artery in your wrist or thigh is numbed and a thin tube is placed with ultrasound guidance. A catheter is guided to the arteries around the hip, and contrast dye shows them on X-ray.

3. 3
   Embolization

   A microcatheter is placed in each small artery feeding an inflamed area, and tiny particles are slowly released until the abnormal blush fades.

4. 4
   Closing and going home

   The catheter is removed and the puncture is closed with pressure, a wrist band or a small plug, with no stitches. After a few hours of rest you go home.

On the angiogram, inflamed tissue around the hip shows up as a cloudy blush of tiny vessels. After embolization, the blush fades while the main arteries stay open.

1. Day of the procedure
   Rest. No driving, alcohol or important decisions for the rest of the day.
2. Days 1 to 3
   Walk normally. Avoid heavy lifting and hard exercise. Mild soreness in the hip or buttock is common.
3. Weeks 1 to 4
   Some people notice temporary skin discoloration over the hip or buttock. Continue your exercises or physical therapy.
4. 1 to 3 months
   If the treatment works for you, pain relief usually builds over this time. We follow up to see how you are doing.