Trochanteric bursitis, also known as the greater trochanteric pain syndrome (GTPS), is the inflammation of the bursa surrounding the greater trochanter of the femur. Patients with this condition typically experience pain on the outer side of the hip, which may worsen with movement, particularly when standing up, climbing stairs, or lying on the affected side. While it can be caused by hip injuries and overexertion from repetitive physical activities, trochanteric bursitis is also known to result from complications after hip surgery. This causes pain to the patient and lengthens the timeline for post-surgery recovery. 

In this article, we will explore the causes and management of trochanteric bursitis, with a particular focus on cases that occur after surgical procedures.

What is trochanteric bursitis?

Trochanteric bursitis refers to the inflammation of the trochanteric bursa. Bursae are fluid-filled sacs located near joints, allowing movement of the joints by reducing the friction between bones, tendons and muscles. The trochanteric bursa is located on the greater trochanter, an area of the femur near its joint to the hip bone. 

It can become inflamed for various reasons, including hip injuries (e.g. falls or direct trauma), poor posture, overexertion of the body, as well as complications after hip surgery. 

Studies indicate trochanteric bursitis occurs in 3-17% of all patients undergoing total hip arthroplasty, a type of hip replacement surgery, making trochanteric bursitis one of the most common complications of hip surgery.^1,2

As a relatively common condition, most patients are able to make a full recovery from trochanteric bursitis. However, trochanteric bursitis is painful and may lengthen the time spent recuperating after hip surgery. Therefore, it is crucial to comprehend the causes of post-surgical trochanteric bursitis, as well as preventive measures to minimise the risk of this complication. In the unfortunate event that post-surgical trochanteric bursitis occurs, it may also be reassuring to appreciate the management and prognosis of trochanteric bursitis.

Causes

Non-surgical causes

Trochanteric bursitis is caused by physical trauma to the hips or mechanical damage to the hip tissues due to physical stress. Common non-surgical causes include: 

Hip injury

Falling, bumping or otherwise hitting your hip may injure your hip bursa, causing trochanteric bursitis. Hip injuries are more likely to occur during strenuous physical activities, in particular high-impact sports such as football,³ where sudden movements or tackles increase injury risk. Thus, trochanteric bursitis may also result as a secondary complication of sports-related injuries.

Poor posture

Poor posture puts mechanical stress on a person’s hip joints, increasing the risk of trochanteric bursitis. This may be caused by pre-existing health conditions affecting the shape of a patient’s hips, spine and/or legs. Underlying musculoskeletal conditions further increase risk, such as:  

• Scoliosis – a C-shaped or S-shaped curvature of a person’s spine
• Bone spurs – lumps of bone tissue growths on the surface of the bone
• Calcific tendonitis – calcium deposits on the tendon

Having discrepant leg lengths may also increase the likelihood of trochanteric bursitis; this effect can be simulated by walking or running on uneven surfaces for prolonged periods of time.⁴

Overexertion 

Overexertion of the body may result from intense or repetitive physical activities, such as lifting heavy boxes, standing and walking over a long period of time. The repetitive motions constantly aggravate the trochanteric bursa, leading to a buildup of physical stress. Sports which involve repetitive motions, such as running and tennis,³ are more likely to cause trochanteric bursitis. People whose jobs involve manual labour, such as heavy lifting, are also at a higher risk of trochanteric bursitis.

Those with physically demanding jobs (construction workers, movers) or who participate in high-repetition sports are particularly vulnerable, as the cumulative stress can overwhelm the bursa’s ability to recover, resulting in inflammation and pain. 

Post-surgical complications

Trochanteric bursitis is a recognised complication of total hip arthroplasty, with a direct lateral approach during surgery carrying a higher risk than the anterior approach due to greater soft tissue disruption.¹ However, it is a relatively minor complication that is easily treated.²

Post-surgical cases often stem from iatrogenic trauma, such as incomplete healing of divided muscles or tendons (particularly the gluteus medius), which chronically irritates the bursa. Some patients may also experience a limb or altered gait post-surgery, due to a loss in strength and/or flexibility of the muscles around the hip. This causes additional stress to the surgical area, increasing the risk of post-surgical trochanteric bursitis. 

Symptoms 

The main symptom of trochanteric bursitis is localised hip pain. The sensation originates as a sharp, burning pain on the outside of the hip, potentially radiating down the patient’s upper thigh and buttocks. When pressing the patient’s hip on the affected side, a point of tenderness over the greater trochanter is felt. The pain may increase with movement, particularly when standing from a seated position and/or climbing stairs. 

Nocturnal symptoms are common, with many patients reporting exacerbated pain when lying on the affected side. While mild cases may resolve with rest, persistent pain beyond several days warrants medical evaluation. Bone scans, computed tomography (CT) scans, and magnetic resonance imaging (MRI) may also be used to rule out alternative conditions.⁵

Prevention

How can the risk of post-surgical trochanteric bursitis be reduced? 

A direct anterior approach during hip replacement surgery is shown to be more protective than a direct lateral approach,¹ making trochanteric bursitis less likely. Post-operatively, engaging in targeted physical therapy is crucial to restore hip muscle strength and normalise gait patterns, helping patients regain proper posture during standing and walking. Surgeons may prescribe temporary mobility aids such as crutches or walkers to offload stress from the healing hip joint during early recovery. Additionally, patients should adhere to their rehabilitation programme, including prescribed stretches and activity modifications, while avoiding overexertion. These combined strategies work to prevent excessive irritation of the trochanteric bursa, allowing for safer recovery and reducing the likelihood of this painful complication. 

Remember - a gradual, measured approach to post-surgical recovery gives your body the best chance to heal properly.

Management and prognosis

In the unfortunate case, post-surgical trochanteric bursitis does occur, most patients recover quickly with bed rest and minimal medical interference. Here is some information on how trochanteric bursitis is managed:

Take a break

Don’t be stubborn and power through the pain! Avoid physical activities which aggravate the inflamed area, such as standing and walking for long periods of time, climbing stairs, and sleeping while lying on the affected side of the body. This allows the trochanteric bursitis to heal while making the recovery process a lot less painful. 

Mobility aids

Mobility aids, such as canes and crutches, are often recommended to reduce the strain placed on the patient when walking. This decreases the stress placed on the trochanteric bursa, helping to reduce the pain the patient experiences while allowing the inflamed bursa an opportunity to heal.

Painkillers

Taking non-steroidal anti-inflammatory drugs (NSAIDs), a type of painkiller, helps to manage the inflammation and reduce pain.⁵ While NSAIDs are typically available over the counter in pharmacies, it is best to consult a pharmacist or doctor if you are taking other medications at the same time. 

Physical therapy

Physical therapy may be prescribed to increase the hip strength and flexibility of the patient. Stretches to strengthen hip, leg and gluteal muscles help reduce inflammation and pain. It restores mobility to the inflamed region, strengthening the hip to provide better structural support while correcting the patient’s posture to prevent future relapses. Physical therapy is not only a preventative method, but it also aids recovery by rehabilitating the body instead of focusing solely on suppressing symptoms. 

Corticosteroid injections

Corticosteroid is a type of steroid hormone which reduces inflammation. For cases unresponsive to the above non-invasive treatments, injecting corticosteroid directly into the trochanteric bursa may be able to reduce pain and improve the mobility of patients. Most patients are able to permanently recover from trochanteric bursitis after one corticosteroid injection, but a small subgroup of patients may find the relief to be temporary and require multiple injections to completely recover.²

Surgery

If trochanteric bursitis persists even after multiple injections of corticosteroid, surgery may be considered to remove the inflamed bursa. This situation is very rare. Keyhole surgery is typically used, a minimally invasive technique where small incisions are made to insert cameras and other surgical tools into the body, which are then used to remove the trochanteric bursa. This technique reduces tissue scarring compared to traditional surgery, thus improving the patient’s overall post-surgical recovery.

Due to the risk of complications associated with any surgery, it is usually considered a last resort for chronic trochanteric bursitis. 

Summary

Trochanteric bursitis is a condition in which the bursa surrounding the greater trochanter often develops as a post-operative complication following hip surgeries like total hip arthroplasty.  While generally considered a minor surgical complication, it causes significant localised pain on the lateral hip and thigh that typically worsens with movement or pressure (particularly when lying on the affected side). Diagnosis is primarily clinical, with physicians identifying characteristic tenderness over the greater trochanter during physical examination.

Physical therapy after surgery reduces the risk of trochanteric bursitis. In cases where trochanteric bursitis occurs, NSAIDs and physical therapy are common treatment methods, with corticosteroid injections only used for persistent cases. Refractory cases may require corticosteroid injections, with surgical bursectomy reserved only for persistent symptoms unresponsive to all conservative treatments. The prognosis is excellent, with most patients achieving full recovery through non-invasive approaches.