Decreasing the inflammation of the bursa is the primary treatment goal for hip bursitis. The best way to decrease inflammation will depend on the underlying cause and severity of the inflammation. In cases of septic bursitis, in which the bursa is infected, antibiotics also must be used to prevent the spread of infection.
Most cases of hip bursitis are successfully treated with nonsurgical treatments and do not re-occur.1 Surgery to correct trochanteric bursitis is rare.
Nonsurgical Treatments for Hip Bursitis
Doctors who treat hip bursitis include primary care providers, physiatrists (physical medicine and rehabilitation specialists), sports medicine doctors, and orthopedic surgeons. Recommended treatments may include:
- Rest and activity modification. When hip bursitis stems from injury or overuse, rest and other remedies to relieve inflammation are usually successful. People with hip bursitis should avoid activities that will aggravate and inflame the bursa, which may include sports and/or standing for long periods of time. In addition, a health care provider may advise taking pressure off the hip by using a cane, crutches, or shoe inserts.
- Ice. Applying ice or a cold pack to the sore hip can help reduce local pain and swelling. This treatment is recommended after any exercise or activity that may inflame the hip bursa.
- Non-steroidal anti-inflammatory drugs, or NSAIDs. Anti-inflammatory medications, such as aspirin, ibuprofen, naproxen, and cox-2 inhibitors (Celebrex) can reduce swelling and inflammation and relieve any pain associated with hip bursitis.
Potential side effects from regular NSAID use include gastrointestinal, heart, and kidney problems.2 For this reason, doctors typically do not recommend taking NSAIDs daily for an extended period of time.
- Topical anti-inflammatory medications . Many topical pain relievers are sold over-the-counter and contain salicylates, which have a mild anti-inflammatory effect. Examples of topical salicylates include many Aspercreme and Sportscreme products. Topical medications tend to have fewer side effects than oral NSAIDs. Certain other topical products require a physician’s prescription.
- Aspiration to drain the hip bursa. If the hip bursa is significantly swollen, the physician may recommend aspirating, or draining, the bursa using a needle. (Aspiration may also be considered part of the diagnostic process, if the removed fluid is sent to a lab for testing.) A cortisone injection may be given following the aspiration.
- Corticosteroid injection. If symptoms are not successfully treated with rest, NSAIDs, and/or physical therapy, a corticosteroid injection may be recommended. Because the affected bursa lies deep beneath the skin, the doctor may use ultrasound to accurately place the injection into the bursa.
- Physical therapy. A doctor may prescribe physical therapy to help treat the current bursitis and prevent future flare-ups. The goals of physical therapy may include strengthening the quadricep and gluteal muscles and stretching the iliotibial band (IT band). Athletes may learn proper running and jumping form.
- Weight loss. If excess weight is a possible underlying cause of hip bursitis, then losing weight can be part of a successful treatment plan.
- Extracorporeal shock wave therapy (ESWT). Some doctors may recommend extracorporeal shock wave therapy, which uses sound waves to stimulate healing. This treatment is not typical but may be recommended for a diagnosis of greater trochanter pain syndrome.
- Needle tenotomy (percutaneous tenotomy). Needle tenotomy involves poking tiny holes in the tendon in order to promote the creation of new, healthier tendon tissue. This procedure is done with a local anesthetic and needles that pierce through the skin and tendon. Tenotomy can be combined with lavage (a procedure that “washes away” calcified deposits in the tendon), a corticosteroid injection, a PRP injection, and/or prolotherapy.
Tenex is a form of needle tenotomy that uses ultrasonic energy. It requires a specialized, patented machine that a doctor must be trained to use. The Tenex probe is inserted through a small incision in the skin. Like traditional tenotomy, patients receive local anesthetic.
- Antibiotics. Septic trochanteric bursitis requires treatment with antibiotics. The choice of antibiotic may be influenced by what microorganism is causing the infection.
Most people with septic bursitis are effectively treated with oral antibiotics. More challenging cases may require hospitalization and antibiotics delivered intravenously.
It is important to wait until all hip bursitis symptoms are gone before resuming regular activities. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause hip bursitis symptoms to flare up again.
Surgery for Hip Bursitis
Particularly challenging cases of chronic hip bursitis may warrant surgery, such as:
- Bursectomy. In a traditional bursectomy an incision is made at the hip and the affected bursa is removed. Some doctors perform arthroscopic bursectomies through a small incision, with the intention of lowering the risk of complications and shortening the healing period.
- Tendon repair and iliotibial (IT) band release. When the IT band is too tight or a tendon is injured it can result in friction and irritation of the trochanteric bursa. Surgery can be done to lengthen the IT band—called IT band release—or repair the injured tendon. These soft tissue corrections and repairs can reduce the unwanted friction.
- Osteotomy of the greater trochanter. Osteotomy is defined as the surgical cutting of bone. During this osteotomy procedure, a surgeon will shave off a small portion of the protruding greater trochanter bone (which is part of the femur, or thigh bone). This adjustment can reduce the friction and stress that caused the hip pain.
More than one of these procedures may be done during the same surgery. The type of surgical procedure recommended depends on symptoms and other factors, such as the patient’s overall health and lifestyle.