What is Hip Bursitis?

As a hip and knee surgeon, one of the most common issues that I encounter is hip bursitis. But what is it exactly?

A bursa is a small, jelly-like sac that contains a small amount of fluid. It is positioned between bones and soft tissues and serves as a cushion to reduce friction.  Bursitis is simply inflammation of the bursa. The most common bursa affected around the hip is the trochanteric bursa, which covers the bony point of the proximal femur (hip bone).

Hip bursitis usually presents as pain at the point of the hip. It can extend to the outer thigh. Initially, the pain is usually sharp and focal, but it can become more achy and affect larger portions of the hip over time. People commonly describe pain at night when lying directly on the affected hip. Walking or stairs may also exacerbate the pain. Bursitis is usually associated with overuse, traumatic injury, concurrent spine disease, leg-length inequality, and previous surgery.

Fortunately, the majority of people with hip bursitis improve with non-operative treatment.  Initial treatment may consist of avoiding activities that worsen symptoms, anti-inflammatory medications for pain, short-term use of a cane or crutches with walking, physical therapy, or corticosteroid injections. Patients who do not improve with these more conservative treatments may benefit from surgical removal of the bursa.

The ideal treatment for bursitis, however, is prevention. The keys to prevention include avoiding repetitive activities that put stress on the hips, maintaining a healthy body weight, getting a properly-fitting shoe insert for leg-length differences, and maintaining strength and flexibility of hip muscles.

It is important to note that hip bursitis can become a chronic issue for some patients. A retrospective study of 164 patients with trochanteric pain found that 36% were symptomatic after 1 year and 29% were still symptomatic after 5 years.

Resources
•    Lievense A, Bierma-Zeinstra S, Schouten B, et al. Prognosis of trochanteric pain in primary care. Br J Gen Pract. 2005 Mar. 55(512):199-204.