Trochanteric Bursitis

What is Trochanteric Bursitis?

The hip has two large bursae. Bursae are jelly-like sacs located throughout the body that are positioned between bones and soft tissue to reduce friction.

One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis.

The iliopsoas bursa is found on the groin side of the hip between the anterior joint capsule and the iliopsoas tendon

Causes of Trochanteric Bursitis

Trochanteric bursitis may result from one or more of the following events:

• Injury to the point of the hip – including falling onto the hip, bumping the hip into an object, or lying on one side of the body for an extended period
• Overuse due to recreational, sporting, or work activities causing friction to the bursa on the side of the hip – including running up stairs, climbing, or standing for long periods of time
• Incorrect posture – resulting from scoliosis, arthritis of the lumbar spine, and other spinal problems
• Soft Tissue Stress – abnormal or poorly positioned joint or bone (leg length discrepancies or arthritis in a joint)
• Other Conditions – like rheumatoid arthritis, gout, and psoriasis,
• Previous Hip Surgery – may cause scar tissue that can contribute to bursitis
• Bone Spurs – or calcium deposits in the tendons that attach to the trochanter.
• Abductor tendon degeneration at their point of attachment into the greater trochanter

Bursitis is more common in women and in middle-aged or elderly people. In many cases, however, the cause of trochanteric bursitis is unknown.

Symptoms of Trochanteric Bursitis

Typically, trochanteric bursitis causes pain around the greater trochanter at the side of the hip:

• At the point of the hip, outside of the hip and thigh, and in the buttock
• When walking upstairs or squatting
• During activities such as getting up from a deep chair
• When lying on the affected side
• When pressure is on the outside of the hip

In the early stages the pain is usually described as sharp and intense. Later on the pain may become more of an ache and spread across a larger area of the hip and lateral thigh.

Diagnosis of Trochanteric Bursitis

The diagnosis is usually made by:

• Taking a medical history
• Performing a physical examination
• Imaging tests

Imaging Tests

• X-rays may show calcification and bony spurs at the trochanter
• MRI scans will usually show fluid within the inflamed bursa, and are also useful to show any degeneration of the abductor muscles and tendons that attach to the trochanter
• Ultrasound scans may show fluid in the bursa

Untreated Trochanteric Bursitis

Most cases of acute trochanteric bursitis improve without any treatment over a few weeks. Some cases persist and become chronic.

Treatment of Trochanteric Bursitis

Treatment goals include reducing pain and inflammation, preserving mobility, and preventing disability and recurrence. Treatment recommendations may include a combination of

• Rest,
• Splints
• Heat

More advanced treatment options include:

• Non-steroidal anti-inflammatory drugs.
• Corticosteroid injections- can work quickly to decrease the inflammation and pain
• PRP (protein rich plasma) injections
• Physical therapy that includes range of motion exercises and splinting.

Surgery is rarely required but may be recommended when other treatments are not effective or when there is tearing and degeneration of the gluteal muscle tendons that attach to the greater trochanter.

Trochanteric Bursitis Surgery

Recalcitrant trochanteric bursitis can be treated with bursectomy and iliotibial band (ITB) release.

Occasionally, a formal abductor repair may be required if a tear in the gluteal tendons is present.

Removal of the trochanteric bursa does not damage the hip, and the hip can function normally without it.

This is performed via a minimally invasive approach removing the bursa through a small incision over the hip.

Preparing for Trochanteric Bursitis Surgery

If surgery is required, preparation is necessary to achieve the best results and a quick and problem free recovery.

Participating and completing a tailored exercise program before (pre-hab) with a trained physiotherapist will achieve the best result after surgery.

• Discuss any medications being taken with your doctor or physician to see which ones should be stopped before surgery
• Do not eat or drink anything, including water, for 6 hours before surgery
• Stop taking aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding one week before surgery
• Eat a well-balanced diet, supplemented by a daily multivitamin with iron.
• Stop or cut down smoking to reduce your surgery risks and improve your recovery

After Trochanteric Bursitis Surgery

Recovery

Most patients will need one night in hospital, although it is possible to leave hospital the day of surgery. The incisional wounds take about 10 days to heal.

Most patients improve dramatically in the first 6-12 weeks. Occasionally, there are periods where the hip may become sore and then settle again. This is part of the normal healing process.

Continued improvements may be gained up to 1 year post-surgery.

Mobility

Walking – full weight-bearing and walking is allowed immediately. Initially, this will be aided by crutches. Most people will walk independently by 10-14 days post-operatively.

Driving – do not drive for 48 hours after an anaesthetic. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, and the type of vehicle you drive, manual or automatic.

If you had a left hip procedure and drive an automatic, you can drive whenever you feel comfortable. Otherwise, it is reasonable to drive when you are confident with walking and can fully weight-bear on your affected side. Do not drive if you are taking strong analgesics. e.g. Endone, codeine etc.

Return To Work After Trochanteric Bursitis Surgery

Return to work will vary depending on the procedure performed and type of work you are engaged in. Most people can return to office work within 2 weeks. Labour intensive work however, may require you to take 6-8 weeks before returning to full duties.

During these period patients are not fit to perform work duties that involve:

• Prolonged standing,
• Heavy lifting,
• Bending or
• Excessive stair climbing

Return To Sport

Low impact activities, such as cycling and swimming, can be commenced from week 4.

You should increase your activity level gradually within comfort limits.

Post-Operative Rehab

Participating and completing a tailored exercise program after surgery with a trained physiotherapist will achieve the best result for you after surgery.