For hip arthritis or bursitis that has outlasted the injections — and isn’t ready for a replacement
Hip embolization is a non-surgical, same-day procedure for hip arthritis and greater trochanteric bursitis that keep flaring despite conservative care and injections. Through a pinhole in the groin, an interventional radiologist quiets the abnormal blood vessels feeding the inflamed joint or tendon with a temporary agent that dissolves within the hour. Twilight sedation, 45 to 90 minutes, home the same day — no incision, no implants, no months of rehab.
Covered by most insurance, including Medicare No serious complications in the published hip studies No referral or prior authorization needed for your initial consultation
Maybe you came here from our hip pain page, wanting to know what this procedure actually involves.
Maybe an orthopedist said “not bad enough yet” — or “too young” — and someone else mentioned “embolization,” and you’ve been trying to find out what it is. Is it surgery? Do they go into the joint? Am I awake? Who even does this?
Or maybe you’re just tired — of the recliner, the slip-ons, the cortisone that buys six weeks, of being told to come back when it’s worse.
This page tells you what the procedure is, what the studies show, and who it’s for — including who we’ll point toward a replacement instead. Straight answers, start to finish.
The procedure
Hip arthritis wears the joint. Bursitis irritates the tendon and bursa on the outside of the hip. What they share is the part the X-ray doesn’t show. When a joint or a tendon stays irritated long enough, the body grows abnormal new blood vessels into the area — and new pain nerves grow right along with them. The inflammation feeds the vessels, the vessels feed the inflammation, and the loop runs day and night. That’s why the ache is deep and constant, why it wakes you when you’re lying still, and why it can be so much worse than the X-ray “looks.”
Hip embolization goes at that loop directly. Through a pinhole in the groin, an interventional radiologist guides a catheter thinner than a phone-charger cord to the small arteries feeding the hip. Dye makes the abnormal vessels show up as a blush the healthy tissue doesn’t have — around an arthritic joint and around an inflamed trochanter alike. There, a temporary slurry of microcrystals blocks the abnormal vessels while the normal blood supply to the hip keeps flowing — then dissolves into the bloodstream within the hour, so nothing permanent stays behind. The inflammation loop loses its supply line; pain eases over the following weeks. It treats the source of the inflammation — not the symptom schedule.
It’s the same mechanism behind genicular artery embolization, the knee-arthritis procedure we perform every week — same doctors, same suite, same temporary agent. The knee has the deeper research record; the hip is newer, and the early studies show the same shape: a fantastic safety profile, and real, meaningful relief.
What it treats
Pain in the groin or the front of the hip, stiff after sitting, the reason the socks won’t go on. Hip embolization is for arthritis that keeps flaring after conservative care and injections — when the joint isn’t advanced enough for a replacement, surgery isn’t safe for you right now, or you’re not ready. The largest hip studies were built on exactly these patients.¹ ⁵ Start with our hip pain page.
Pain on the outside of the hip, tender to press, the one that won’t let you lie on that side. Cortisone quiets it without touching what feeds it — so it comes back. For severe bursitis that returns after every shot, hip embolization goes after the supply line itself, and in the published series bursitis patients did as well as the arthritis patients.¹ ² ³
Step one is always the implant: it has to be confirmed sound — not loose, not infected, not out of position — and that’s your surgeon’s call. If the implant is fine and the pain is inflammatory, it’s something we evaluate. We do the same for knees.
Which one is driving your hip — or whether it’s your back — is the first thing we settle. We examine, we image, and we say which, before we treat anything.
See it for yourself — in motion
These are angiograms — X-ray pictures taken while dye flows through the arteries — from hip embolizations performed here at ARVC. Two different problems, two different vessels — which is the point of settling the diagnosis first. In each before loop, the dark tangle (arrow) is the crowd of abnormal vessels feeding the inflamed tissue, flooding in with the dye. In the after loop, minutes later: the blush no longer fills, and the artery itself is still open.
Before
After
Before
After
Angiograms from hip embolization procedures performed at ARV Centers, San Antonio, with patient identifying information removed. Individual results vary — the study data below is the fairer way to set expectations.
What the research shows
The procedure we’ve done the most, and the one with the most research behind it, is genicular artery embolization for knee arthritis. The knee has been studied the longest and most widely, and the finding is consistent: block the abnormal blood vessels feeding an inflamed joint, and the pain settles. Doctors then asked whether the same approach would help other joints — and the results in shoulders, hips, and even the plantar fascia in the foot follow the same pattern as the knee.
That matches what we see in our own practice. We’ve performed more than 700 knee embolizations, along with shoulders, hips, and feet, and in our experience all of them are highly effective — most of the patients we treat get real, meaningful relief. The hip research is newer and smaller than the knee’s, and we’ll always tell you that. Here’s what it shows.
The hip studies tell a consistent story. In the largest — 49 patients with hip arthritis or bursitis, followed for a year — average pain fell from 7.8 to 4.0 out of 10, and about 3 in 4 of those followed the full year had at least a 50% improvement in pain or function.¹ The bursitis finding matters to us, because we see a lot of it: in that study, patients whose problem was purely trochanteric bursitis did just as well as the arthritis patients.¹ In an earlier six-month series — 13 patients, 10 of them with bursitis — the standard hip pain-and-function score fell from 77 to 27.³ And in a 31-patient bursitis series, 21 of 38 hips reached mild pain (0–3 out of 10) at last follow-up, 7 more improved to moderate, and 9 didn’t improve — worth knowing going in.² That’s why we offer embolization for severe, recurring bursitis rather than sending you back for a fourth cortisone shot.
One study looked only at people who couldn’t have a hip replacement — 18 patients over 60, each with a medical reason surgery wasn’t safe — and saw pain fall from 7.8 to 4.3 out of 10 at 12 weeks, with no complications. Its authors called embolization a bridge between conservative care and surgery. That’s how we think of it too.⁴
And the newest series — 41 patients in Berlin, every one with confirmed hip arthritis, most of it moderate to severe on X-ray — shows the same shape: pain 7 to 4 out of 10 at six months, holding at twelve; about 2 in 3 with a meaningful pain improvement and roughly 9 in 10 with a meaningful gain in daily function; no serious complications and no damage to the ball of the hip joint. The two patients who didn’t respond went on to hip replacement afterward — embolization didn’t close that door.⁵
Across every published series, the procedure has been safe and well tolerated — no serious complications; the side effects were groin bruises, a temporary patch of thigh numbness and a brief patch of skin discoloration, all cleared on their own¹ ² ³ ⁴ ⁵ — and it leaves nothing permanent behind. For a hip that’s “not bad enough” to replace and too bad to live with, that’s what makes it worth a conversation: a safe, reliable, effective treatment that doesn’t involve an incision or an implant.
We do a complimentary benefits check before any procedure. No surprises.
Sources: 1. Cavalheiro et al., HipE Study, Cardiovasc Intervent Radiol 2026;49(7):1295–1305 — prospective single-arm, single-center; 49 treated, 37 completed 12 months (31 hip OA, 6 pure trochanteric pain syndrome); imipenem/cilastatin; VAS 7.84→3.97, WOMAC 54→24; clinical success (≥50% reduction in WOMAC or VAS) 73% of completers; two grade 1a groin hematomas; no significant difference between the OA and pure-GTPS subgroups. 2. Giordani et al., Latino-Hip cohort, Cardiovasc Intervent Radiol 2025;48(4):538–542 — single-center registry (retrospective analysis of a prospective cohort), 31 patients / 38 joints with trochanteric pain syndrome refractory to conservative care; at last follow-up 21 joints VAS 0–3, 7 joints VAS 4–6, 9 joints unimproved (VAS 7–10); one lost to follow-up; two minor complications (posterior thigh numbness, resolved within 30 days). 3. Correa et al., Cardiovasc Intervent Radiol 2022;45:1710–1715 — 13 patients (10 GTPS, 3 hip OA), 6 months: WOMAC 77→27, VAS 10→2; two transient numbness. 4. Feier et al., Cureus 2025;17(11):e96060 — 18 patients ≥60 with a contraindication to hip replacement, Tönnis grade I–II: VAS 7.8→4.3 and Harris Hip Score 45.5→62.1 at 12 weeks; no adverse events. 5. Fleckenstein et al., Cardiovasc Intervent Radiol 2026;49:1352–1361 — retrospective single-center, 41 patients with radiographic hip OA (KL III 68%, KL IV 27%), ≥3 months failed conservative care; technical success 40/41; median NRS pain 7→4 at 6 and 12 months; MCID reached by 64% (pain) and 85–92% (HOOS domains) at 12 months; 12-month follow-up in 28/41; no major or moderate adverse events, 3 transient skin discolorations; two KL IV non-responders proceeded to hip replacement at 7 and 9 months. Sources 1–2 abstract-verified, 3–5 full text — full texts before any print or ad use.
Procedure day
A consultation, an exam, and imaging come first. We confirm what’s actually driving the pain — arthritis in the joint, bursitis on the outside, or pain borrowed from your back — with an exam and X-ray, and sometimes MRI or ultrasound. If your hip’s story doesn’t fit what the procedure treats, we’ll say so — and point you to what will help instead.
You get comfortable. An IV delivers light twilight sedation — you’re relaxed and drowsy, breathing on your own, with a dedicated sedation nurse watching over you the whole time. Not general anesthesia: most patients say it feels like a strong margarita, and it wears off fast.
The pinhole. The doctor numbs a spot in the groin and makes a pinhole opening in the artery. No incision, no stitches. A brief pinch is the only thing you should feel, because blood vessels themselves have no pain nerves.
The map. A catheter travels to the small arteries feeding the hip, dye flows, and X-ray pictures reveal the abnormal vessels — a blush around the arthritic joint or the inflamed trochanter that healthy tissue doesn’t have.
The treatment. The doctor releases a temporary slurry into each abnormal cluster — an antibiotic (imipenem/cilastatin) mixed with X-ray dye, which forms microcrystals smaller than a grain of sand — leaving the healthy arteries to your hip and leg flowing. The crystals quiet the abnormal vessels, then dissolve into the bloodstream within the hour; nothing permanent stays behind. It’s the same agent used in the published hip studies. All told, you’re usually on the table 45 to 90 minutes.
Sealed and resting. The catheter comes out, the pinhole is sealed, and you rest with us for about an hour in a recliner. Plan on three to four hours all told.
Home — walking. Someone drives you. Light walking the same day; nothing strenuous for 48 hours; easy on the hip for a week or two. Expect mild bruising or an ache at the pinhole for a day or two — most patients manage the first day with over-the-counter pain relievers — and we call you the next day to check in.
Don’t take our word for any of it: the exact instruction sheets our patients take home are right here — pre-procedure instructions (PDF) and post-procedure instructions (PDF).
The timeline nobody tells you: this is not a switch. Relief comes on over weeks as the inflammation settles, and a brief flare in the first few days is normal. In the published series, improvement was measured as early as six weeks and continued through three, six and twelve months.⁴ ⁵ If you expect to wake up fixed the next morning, you’ll be disappointed by a procedure that may be working.
The published evidence
7.8 → 4.0
Average pain out of 10, before and 12 months after hip embolization, in the largest study of the procedure — 49 patients with hip arthritis or bursitis. About 3 in 4 of those followed for the full year had at least a 50% improvement in pain or function.¹
21 of 38
Hips with stubborn trochanteric bursitis that reached mild pain (0–3 out of 10) at last follow-up in a 31-patient series — with 7 more improved to moderate, and 9 that didn’t improve. Worth knowing going in.²
7 → 4
Pain out of 10 at six months, holding at twelve, in the largest pure hip-arthritis series — 41 patients in Berlin, most with moderate to severe arthritis on X-ray. Roughly 9 in 10 had a meaningful gain in daily function.⁵
Zero
Serious complications reported across the published hip series. The side effects were groin bruises, a temporary patch of thigh numbness, and a brief patch of skin discoloration — all cleared on their own.¹ ² ³ ⁴ ⁵
The pattern across every study: relief that arrives over weeks, in people who had already failed conservative care, and holds for as long as anyone followed them — twelve months in the two largest series.¹ ⁵
What we say plainly: the hip research is newer and smaller than the knee’s. The early studies show a fantastic safety profile and an effective procedure — and that’s what we see in our own patients.
Sources are numbered as in “What the studies say” above: 1. Cavalheiro et al., HipE Study, Cardiovasc Intervent Radiol 2026 (49 treated, 37 completed 12 months). 2. Giordani et al., Cardiovasc Intervent Radiol 2025 (31 patients / 38 joints). 3. Correa et al., Cardiovasc Intervent Radiol 2022 (13 patients). 4. Feier et al., Cureus 2025 (18 patients). 5. Fleckenstein et al., Cardiovasc Intervent Radiol 2026 (41 patients; 12-month follow-up in 28).
Candidacy
We turn away patients who aren’t candidates for what we do. Routinely. And you leave with a plan either way.
Insurance and cost
Hip embolization is covered by most insurance plans, including Medicare. We still confirm your specific plan before anything is booked: a complimentary benefits check before any procedure. Usually, on the day of your consultation, we can tell you what your benefits are for the treatment you’re interested in. If your plan requires a referral or prior authorization for treatment, we identify that during the check and help you get it.
And this procedure has to earn its place against the other rungs — therapy, a precision image-guided injection — and if one of those fits your hip better, that’s what we’ll recommend. If a replacement is honestly the right road, you’ll hear that from us too.
If we don’t think a treatment is worth your money, we’ll tell you that in the room.
Your care team
Your consultation starts with a provider reading your history and your imaging with you. The procedure itself is performed by our Board Certified Vascular and Interventional Radiologists, in our own angiography suite — not a hospital. And if a precision image-guided injection is the better first rung for your hip, that happens under the same roof — see our hip pain page for the whole ladder.
After your procedure
When you go home, you take the on-call doctor’s cell phone number with you. Not an answering service — the doctor.
And you don’t have to wonder whether to bother us: we call you the next day to check in. Every patient, every procedure.
Before you leave, you’ll get this card
Your procedure:
On-call doctor:
Cell phone: written by hand, before you walk out
Call me if anything worries you.
Straight answers
Same idea, different address. Genicular artery embolization (GAE) treats the abnormal vessels around an arthritic knee; hip embolization does the same for the hip. The knee version has the most research behind it; the hip uses the identical technique, the same temporary blocking agent, and the same team — and in our experience the results track. Knee Pain & Arthritis →
It’s newer, and it’s real. Five published series — all patients with hip arthritis or bursitis that had failed conservative care — saw average pain fall from about 7 or 8 out of 10 to about 4, with relief that held for as long as they were followed and no serious complications.¹ ² ³ ⁴ ⁵ The technique — blocking abnormal vessels through a catheter — has been used for decades elsewhere in the body, and it’s the same one our doctors use every week for knees and shoulders. The hip research is newer and smaller than the knee’s; the early studies show it’s safe and effective, and we’ll always tell you that.
Where it hurts, what makes it worse, and what we find when we press. Pain in the groin or the front of the hip — stiff after sitting, worse putting on socks — is usually the joint. Pain on the outside of the hip that’s tender to the touch and won’t let you lie on that side is usually trochanteric bursitis. Pain in the buttock that runs down the leg may be your back, not your hip at all. Then imaging confirms it — X-ray, and sometimes MRI or ultrasound. Often it’s some of both, which is one reason a hip that’s been “treated for bursitis” three times can still hurt.
That pattern is the signal. Cortisone quiets the inflammation without touching what’s feeding it — the abnormal vessels are still there when the medication fades, so the loop restarts, usually a little sooner each time. For bursitis that’s severe and keeps returning, hip embolization goes after the supply line itself — and patients exactly like that are who the published bursitis series were built on. Bring your history; we’ll tell you if you’re there.
You’ll be under twilight sedation — relaxed, drowsy, breathing on your own, with a nurse watching you the entire time. It’s not general anesthesia: no breathing tube, and a much quicker recovery. The pinhole in the groin is numbed first, and a brief pinch is the only thing you should feel — blood vessels themselves have no pain nerves. Most people describe pressure rather than pain, and go home the same day with mild bruising in the groin.
Weeks, not days. Relief builds as the inflammation settles, and a brief flare in the first few days is normal. In the published series, improvement was measured as early as six weeks and continued through three, six and twelve months.⁴ ⁵ If you’re expecting to wake up fixed, this isn’t that — and we’d rather say so now.
Across the published hip series, no serious complications have been reported. The side effects were groin bruises, a temporary patch of thigh numbness, and a brief patch of skin discoloration — all cleared on their own.¹ ² ³ ⁴ ⁵ It’s a safe, well-tolerated procedure. Every catheter procedure carries a small risk of bruising or bleeding at the pinhole and of a reaction to contrast dye. One thing careful people ask about the hip specifically: the ball of the hip joint has its own delicate blood supply, which is one reason a temporary agent matters — in the largest hip-arthritis series, there was no damage to it.⁵ If you have significant artery disease in the leg or a serious contrast allergy, this may not be for you — and we review the rare risks with you in plain language before you decide anything.
Maybe — and if that’s the honest answer, you’ll hear it from us. Total hip replacement is one of the most successful operations in medicine. If your arthritis is advanced, you’re a good surgical candidate, and you’re ready, that’s usually the right road. What we treat is everyone who isn’t there yet: not advanced enough, not safe for surgery right now, or not ready — and everyone whose problem is bursitis, which a replacement was never going to fix. And embolization doesn’t burn the bridge: in the published series, the few patients who didn’t respond went on to have a replacement afterward.⁵
The published hip studies were mostly patients in their 60s and 70s — and one was built entirely on patients over 60 whose health ruled surgery out.⁴ Age matters less than what’s driving the pain. “Too young for a replacement” is precisely the situation this procedure exists for — the years between “come back when it’s worse” and surgery don’t have to be endured untreated.
Sometimes. Step one is always the implant: it has to be confirmed sound — not loose, not infected, not out of position — before we would consider treating inflammation around it. That’s your surgeon’s call and it comes first. If the implant is fine and the pain is inflammatory, it’s something we evaluate. We do the same for knees →
Both-hip cases were treated in the published series.³ Whether to do them together or one at a time is something we’d decide with you.
Then you’re where you were, minus a day — nothing was cut, nothing permanent was left behind, and every other option is still on the table, including a replacement. In the published series, the few patients who didn’t respond went on to have one afterward.⁵ That’s the honest answer, and it’s a real part of the decision.
Yes — hip embolization is covered by most insurance plans, including Medicare. And we still do a complimentary benefits check before any procedure — usually the same day as your consultation — so you know your number before you decide anything.
Free patient guide
Our physicians wrote a plain-English guide to hip pain: what’s actually driving it — arthritis in the joint or bursitis on the outside — what each treatment can and can’t do, from guided injections to embolization to replacement, and how to tell which rung of the ladder fits your hip. No appointment required, and no follow-up phone call unless you ask for one.
We’ll email your guide plus occasional patient education. Unsubscribe anytime. Privacy policy.
You’ll sit with a clinician — not a salesperson. Bring your imaging if you have it — X-ray, MRI, whatever exists. You’ll hear every option, including the ones we don’t offer, and get a straight answer about whether hip embolization fits your hip. Call us directly, or send this form and we’ll call you to schedule. We do a complimentary benefits check before any procedure. No surprises.
210-405-1335Closed on major holidays.
3212 Napier Park, San Antonio, TX 78231
Stand-in image (Map © OpenStreetMap) — the live site embeds the interactive Google map here
No referral or prior authorization needed for your initial consultation.
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