Anatomy of the Hip
A bursa is a small sac of fluid that acts as a cushion between bones and the overlying soft tissues, reducing friction between the bone and muscles. There are four bursae associated with the hip. One, the trochanteric bursa, overlies the greater trochanter, which is the bony point of the hip that serves as a point of attachment for many of the muscles that move the hip joint. This is the largest bursa of the hip and the most common to cause symptoms. Another, called the iliopsoas bursa, is located on the groin side of the hip and lies between the bone the and iliopsoas tendon. The ischiogluteal, or simply ischial, bursa is deep in the pelvis below the hip joint and overlies the ischium of the pelvis. The gluteus medius bursa is near the trochanteric bursa and lies between the femur and the gluteus medius tendon. When any of these bursae become irritated and inflamed, the condition is commonly referred to as hip bursitis.
Causes of Hip Bursitis
Hip bursitis is more common in women and middle-aged or elderly people, but it can affect anyone. Trochanteric bursitis is more common than iliopsoas bursitis. Some of the risk factors include:
- Bone spurs or calcium deposits attached to the trochanter that irritate the bursa
- Previous hip surgery or hip implants can irritate the bursa
- Tightness of the IT band, a thick tendinous band overlying the trochanter
- Rheumatoid arthritis
- Problems that alter alignment and gait, such as leg-length inequality, knee or ankle injuries, or scoliosis
- Hip injury, such as from a fall or car accident
- Repetitive overuse, such as from running or bicycling over long periods of time
The main symptom of hip bursitis is pain in the hip. Some patients describe their pain as sharp and intense, while others feel more of a spread out, dull ache. Typically the pain is worse when lying on the affected side or after periods of prolonged walking, running, stair climbing, or squatting.
The doctor will perform a physical exam to look for tenderness in the hip area and to rule out other possible conditions. X-rays, CT scans, or MRIs may be ordered to rule out other problems as well.
Treatment Options for Hip Bursitis
Many people with bursitis can experience relief without surgery. Early treatment usually consists of:
- Lifestyle modification to avoid activities that worsen symptoms
- Use of over-the-counter or prescription strength nonsteroidal anti-inflammatories for a limited period of time
- Use of a cane or crutches as needed
Another non-surgical option is injection of a corticosteroid and a local anesthetic into the affected bursa, which usually gives immediate and often permanent relief. If the bursitis does return, up to three injections a few months apart may be needed.
If other treatments have failed, minimally invasive endoscopic removal of the bursa is an option. Part of the procedure involves creating an opening in the tight tendinous band overlying the trochanter to prevent recurrence of the condition. The hip is still able to function properly without the bursa, and this surgery can be very effective.
Complications with hip bursitis surgery are uncommon. In a small percentage of cases, the IT band tendon may scar back together and cause recurrent bursitis symptoms. As with all surgeries, there is a risk of infection, damage to surrounding nerves, and blood clots.
The rehabilitation period after surgery is very short. Walking the evening after surgery is reasonable, and soreness is usually gone within a few days.
- How can I prevent hip bursitis?
Keeping the muscles around the hip strong and avoiding tightness of the IT band by stretching are ways to help prevent bursitis. Also, correcting any conditions that may cause a limp such as associated ankle, knee, or low back problems can help the symptoms of bursitis.
- When should I consider surgery for hip bursitis?
If you have tried medicines, multiple cortisone injections, and home exercises or physical therapy and still have persistent symptoms of bursitis for months, then you may be a good candidate for endoscopic bursectomy.
- What is the success rate of endoscopic bursectomy?
Endoscopic bursectomy has a very high success rate of alleviating the symptoms of bursitis, up to 97% is the largest study. Probably the most important predictor of success is relief from cortisone injections. If your bursitis pain is completely relieved for a short time by a cortisone injection, then you will likely get complete relief from the surgery. If the injections do not relieve all of your pain, there may be a condition other than bursitis such as gluteus tendinitis/tear or a low back problem that is responsible for your pain.
If you have more questions, please call my office at 502-394-6341.