When hip pain will not settle, most people end up choosing among a handful of options: exercise-based physical therapy, injections, hip replacement, and, more recently, embolization. These are not equal choices. Some have decades of research and clear guideline support. Hip embolization is new and lightly studied. This article compares them honestly so you can have a better conversation with your doctor. For an overview of embolization itself, see our hip embolization page.
The short answer
For hip osteoarthritis, exercise, weight loss when needed, anti-inflammatory medicines and steroid injections are the guideline-recommended first steps, and hip replacement is the established treatment for advanced arthritis that still limits your life. For pain on the outside of the hip, a structured exercise program is the best-supported treatment. Hip embolization is an emerging option that may be considered when pain persists despite these steps and surgery is not the right next move. It is not a replacement for any of them.
Side-by-side comparison
| Exercise and physical therapy | Steroid injection | Hip embolization | Hip replacement | |
|---|---|---|---|---|
| What it does | Strengthens muscles and improves movement and load tolerance | Reduces inflammation in or around the joint | Reduces blood flow to inflamed tissue around the hip through a catheter | Replaces the worn joint surfaces with an artificial joint |
| Guideline status for hip arthritis | Strongly recommended (ACR 2026) | Strongly recommended, with ultrasound guidance (ACR 2026) | Not included in the 2026 ACR guideline summary | Definitive treatment for advanced disease |
| Strength of evidence | Moderate certainty (ACR 2026) | Low certainty, but strongly recommended (ACR 2026) | Small studies, no placebo-controlled trials | Long-term case series and national registries |
| How long benefit lasts | Lasts with continued exercise | Up to about 4 months (AAOS) | Studied up to about 12 months; longer is unknown | About 58% still working at 25 years (registry data) |
| Recovery | Weeks of regular sessions and home exercise | Usually a day or two | A few days for the procedure itself | Surgery and a longer rehabilitation period |
Exercise and physical therapy: the foundation
The 2026 American College of Rheumatology (ACR) guideline strongly recommends exercise for people with hip osteoarthritis, and weight loss for those who are overweight. It also advises referral to physical therapy when arthritis limits function. The American Academy of Orthopaedic Surgeons (AAOS) guideline gives physical therapy a moderate recommendation, noting that about half of studies found better pain and function than control groups.
For pain on the outside of the hip, exercise has even stronger support. In the LEAP trial of 204 people with gluteal tendinopathy, an eight-week education and exercise program led to better overall improvement than a steroid injection at eight weeks and at one year. A 2025 analysis of 19 randomized trials found exercise therapy was the most effective conservative treatment for this condition.
Whatever else you choose, exercise usually stays part of the plan.
Medicines
Oral anti-inflammatory medicines (NSAIDs) are strongly recommended for hip arthritis by the ACR when they are safe for you, and the AAOS guideline found they consistently reduce hip arthritis pain. Acetaminophen is a conditional option. Both guidelines advise against relying on opioids such as tramadol. Talk with your doctor before taking anti-inflammatory medicines regularly, especially if you have kidney, stomach or heart problems or take blood thinners.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Embolization Guide.
Steroid injections
For hip arthritis, the ACR strongly recommends steroid injections into the joint and strongly recommends using ultrasound guidance for them. The AAOS found that they improve pain and function for up to about four months. They are quick and familiar, but the effect is temporary.
For outer hip pain, the LEAP trial showed that a single steroid injection worked better than waiting at eight weeks. At one year, pain levels were similar between the injection and exercise groups, but the exercise group reported better overall improvement.
Other injections
- Hyaluronic acid (gel) injections: the ACR conditionally recommends against them for hip arthritis, and the AAOS does not recommend them, citing no improvement over placebo.
- Platelet-rich plasma (PRP): the ACR strongly recommends against PRP for hip arthritis. For outer hip pain, a 2025 review called the PRP evidence inconclusive.
- Stem cell injections: the ACR strongly recommends against them for hip arthritis.
Hip replacement
Hip replacement is one of the most established operations in medicine. A 2019 analysis in The Lancet called it common and highly effective, and estimated from national registry data that about 58% of hip replacements still last 25 years. For people with advanced arthritis whose pain and stiffness limit daily life despite other care, it remains the definitive treatment.
It is also major surgery, with a hospital or surgery-center stay, a period of rehabilitation, and surgical risks that your surgeon should review with you. Your general health, weight, diabetes and smoking status can all affect recovery and complication risk.
Embolization studies have not shown that the procedure prevents or delays hip replacement. In the 2026 Berlin study of 41 people, two had hip replacement within the follow-up period, and the authors wrote that embolization did not appear to make later replacement harder. Whether it changes the timing of surgery over many years is unknown.
Where hip embolization fits
Published studies used embolization mostly for people with mild to moderate arthritis or outer hip pain who had not improved with conservative care and were not ready for, or not able to have, surgery. In those small studies, average pain scores improved. For example, median pain fell from 7 to 4 out of 10 at 12 months in the Berlin study, and 73% met the success definition in the 49-patient HipE study.
But no hip study has compared embolization with a sham procedure, and only one compared it with conservative care. That study, of 26 embolization patients and 36 conservative care patients who were too high-risk for surgery, found more improvement with embolization, but the adjusted difference in average pain did not reach the authors' own threshold for clinical importance. A randomized trial now underway in Portugal is comparing embolization with PRP for outer hip pain. You can read the details in our research summary.
How to think about your choice
- If you have not done a structured exercise program, start there. It has the strongest evidence for both arthritis and outer hip pain.
- If you need faster short-term relief, an image-guided steroid injection is a well-supported option.
- If your X-rays show advanced arthritis and your life is limited, see an orthopedic surgeon about hip replacement.
- If you have tried conservative care and are not ready for or able to have surgery, embolization may be worth discussing, with realistic expectations. Our candidacy guide explains who was treated in the studies.
Our page on hip pain treatment without surgery describes the non-surgical options we discuss with patients, and our embolization guide covers how embolization is used in other joints.
Frequently Asked Questions
Is hip embolization an alternative to hip replacement?
Not for advanced arthritis, where hip replacement is the established treatment. Embolization has mainly been studied in people with mild to moderate disease or outer hip pain who were not ready for or able to have surgery.
Does hip embolization last longer than a steroid injection?
Hip embolization studies followed patients for up to about 12 months, while guidelines say steroid injections help for up to about four months. The two have never been compared head to head, so it is not known which lasts longer.
Can I still have a hip replacement after embolization?
Yes. In a 2026 study, two of 41 patients went on to hip replacement, and the authors wrote that embolization did not appear to make later replacement harder.
Are gel or PRP injections good options for hip arthritis?
The 2026 ACR guideline conditionally recommends against hyaluronic acid (gel) injections and strongly recommends against PRP and stem cell injections for hip arthritis.
Keep Reading
- Hip Embolization in Manhattan
- What Is Causing Your Hip Pain? Arthritis, Bursitis and Tendinopathy Explained
- Is Hip Embolization Covered by Insurance?
- Is Hip Embolization Painful? What to Expect Before, During and After
- Hip Arthritis: Symptoms, Diagnosis and Treatment Options
- Hip Embolization: Am I a Candidate?
- Embolization Guide: knee, heel, shoulder, elbow and hip
Sources
- American College of Rheumatology, 2026 — Update of recommendations for management of osteoarthritis of the knee, hip, and hand (summary)
- Arnold, American Family Physician, 2025 — Hip osteoarthritis: guidelines from the American Academy of Orthopaedic Surgeons
- Evans et al., Lancet, 2019 — How long does a hip replacement last? Systematic review and meta-analysis
- Mellor et al., BMJ, 2018 — Education plus exercise vs corticosteroid injection vs wait and see for gluteal tendinopathy (LEAP trial)
- Wang et al., J Orthop Surg Res, 2025 — Conservative treatment for greater trochanteric pain syndrome: network meta-analysis of 19 RCTs
- Gill et al., Cureus, 2025 — Management of greater trochanteric pain syndrome: a narrative review
- Fleckenstein et al., Cardiovasc Intervent Radiol, 2026 — Transarterial embolization for symptomatic hip osteoarthritis (41 patients)
- Cavalheiro, Marinho Lopes et al., Cardiovasc Intervent Radiol, 2026 — HipE study: hip embolization for hip OA and GTPS, 12-month follow-up
- Feier, Bloj et al., J Clin Med, 2026 — Periarticular embolization vs conservative care in surgery-ineligible hip OA (prospective comparative study)
- ClinicalTrials.gov NCT07396246 — HIPE RCT: embolization vs PRP injection for greater trochanteric pain syndrome
Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.
Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.
