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Hip Bursitis

Other popular names

Who does it affect?

Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.

There are a number of factors that are associated with the development of hip bursitis.

When is it used?

Bursitis is caused by inflammation of a bursa which is a small jelly-like sac that usually contains a small amount of fluid. Bursae are located throughout the body, such as around the shoulder, elbow, hip, knee, and heel. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.

The bony point of the hip is called the greater trochanter and is the point of connection for muscles that move the hip joint.  The trochanter has a fairly large bursa overlying it that occasionally becomes irritated, resulting in hip bursitis (trochanteric bursitis).

Another bursa located on the inside (groin side) of the hip is called the iliopsoas bursa. When this bursa becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area. This condition is not as common as trochanteric bursitis, but is treated in a similar manner.

Symptoms

The main symptom of hip bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense.  However, later it may become a constant ache over a wider area.

Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting.

Diagnosis

To diagnosis hip bursitis, the consultant will undertake a physical examination, looking for tenderness in the area of the point of the hip.

You are likely to require an x-ray and possibly MRI scan.

Non-surgical treatment

The initial treatment for hip bursitis does not involve surgery and many people with hip bursitis can experience relief with simple lifestyle changes, including:

There is little evidence to support the use of physical therapy to treat hip bursitis, but many patients claim that it is helpful.  Your consultant may ask a physiotherapist to teach you how to stretch your hip muscles and use other treatments such as ice, heat, or ultrasound.

Injection of a corticosteroid along with a local anesthetic may also be helpful in relieving symptoms of hip bursitis. This is a simple and effective treatment that can be done in the consulting room. It involves a single injection into the bursa. The injection typically provides permanent relief. If pain and inflammation return, another injection or two, given a few months apart, may be needed.

Surgical treatment

Surgery is rarely needed for hip bursitis, however if the bursa remains inflamed and painful after all nonsurgical treatments have been tried, your consultant may recommend surgical removal of the bursa. Removal of the bursa does not hurt the hip, and the hip can actually function normally without it.

Surgery is carried out as a day case procedure under regional or general anaesthetic.  Using an arthroscopic procedure, a simple look around takes about 15 minutes, but if other procedures need to be performed, it can take longer.  Approximately 3 or 4 small 3mm incisions are made around the hip to allow the camera and instruments inside.  Care is taken not to injure the nerves just under the skin.  At the end of the operation a local anaesthetic solution (to reduce the post-operative pain) combined with adrenaline (to reduce bleeding and bruising around the incisions) is normally injected into the joint.

The incisions are covered with a sterile dressing as they do not normally require any stitches. The hip is then wrapped in a soft compressive bandage to help to reduce any swelling and keep the hip comfortable.

Post-surgery rehabilitation

Most patients are able to return home on the same day as surgery. They can often be discharged several hours after surgery as long as they are sufficiently recovered from the anaesthetic, although some patients take longer to recover. Most patients are pain free when discharged.  All patients will need someone to take them home and be with them on the night following surgery.

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The large bandage around the hip is normally removed 24-48 hours after surgery.  The non-stick sterile dressings on the wound are replaced with clean waterproof dressings.

Return to normal routine

Bathing and showering

The wounds should be kept clean and dry until the wound has sealed. Showering is fine and the waterproof dressings can be changed afterwards. Bathing is best avoided until the wounds are sealed, typically 4 to 5 days after surgery.
In summary, whilst the wounds are wet - keep them dry and when the wounds are dry, you can get them wet.

Rehabilitation

Patients should and try to minimize their activities as much as possible in the first few days following surgery. The leg should be rested and elevated as much as possible. Painkillers (supplied on discharge from hospital) and cold packs may be used as required.

Simple exercises, including straight leg raises and other exercises as instructed by your physiotherapist prior to discharge should be performed.

Most patients do not require formal physiotherapy following arthroscopy as all patients are seen and assessed by a physiotherapist prior to discharge from hospital.

Some patients might require physiotherapy either before or after the first post-operative check-up.

Return to activity

Recovery is a gradual process and whilst most patients bounce back quickly following arthroscopy everyone should assume it will take up to 6 weeks to make a full recovery and symptoms can often improve for some time beyond this period.

The speed of recovery depends on the surgery performed, the degree of degeneration found and the age of the patient.

In general, the older the patient and the more degeneration a patient has, the slower and less predictable recovery will be.  Most patients can perform most tasks around the house and return to driving within a few days.  Sedentary/office workers can often return to work a few days after surgery.  Patients performing more physical work might require two to 6 weeks off work depending on their individual positions.  Patients can usually return to sport between 3 to 6 weeks following surgery.

The small wounds can remain tender for a few months following surgery.

Return to driving

The leg needs to have full control of the pedals.  You are advised to avoid driving for at least 7 days or you regain full use of your leg.

Risks

An Arthroscopy is an extremely safe routine operation with a very low complication rate.  Overall over 97% are happy with the result. However complications can occur.

Potential complications include infection, injury to blood vessels and nerves and severe pain and swelling in addition to the rare general complications such as blood clots (DVT) and anaesthetic risks.

In general, the risk of sustaining a complication as a consequence of the operation that leaves you worse off in the long term is less than 1%.

The biggest practical risk is the risk of not being able to improve symptoms as much as desired or at all.  This occurs most commonly due to the presence of degenerative changes.

Most ongoing symptoms following arthroscopic surgery are usually the result of the underlying problem within the hip.

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