Trochanteric bursitis, the inflammation of the bursa (tissue surrounding a joint) surrounding the greater trochanter (outside of the hip bone), can be caused by several factors: hip injuries, poor posture, repeated exertion of the body, and complications after hip surgery. It can also be exacerbated by ageing, leading to pain and a reduced range of movement in the elderly. With an ageing global population, it is crucial to note the challenges posed by trochanteric bursitis, as well as options for managing this condition. 

Introduction

Trochanteric bursitis is the inflammation of the bursa surrounding the greater trochanter. Bursae are fluid-filled sacs surrounding the joints, allowing movement of the joints by reducing the friction between bones, tendons, and muscles; meanwhile, the trochanteric bursa is located on the greater trochanter, an area of the femur near its joint to the hip bone. Trochanteric bursitis is one of the conditions categorised under greater trochanteric pain syndrome, in addition to gluteal tendinopathy – the deterioration of tendons in the hips and buttocks. Patients with greater trochanteric pain syndrome feel pain on the outside of their hips, which is exacerbated by movements such as standing up, climbing stairs, or lying on their inflamed side at night. It is one of the most common causes of lateral(outside) hip pain, appearing in 10-20% of patients with hip pain, and has an incidence rate of 1.8 patients per 1000 individuals per year. This condition is particularly common among people assigned female at birth (AMAB) aged 40-60.¹ 

Trochanteric bursitis can occur for various reasons, including hip injuries, poor posture, repeated exertion of the body, and complications after hip surgery. These causes can be exacerbated by risk factors, including ageing. Due to the prevalence of trochanteric bursitis in older individuals, as well as the challenges this condition poses to their mobility and quality of life, it is important to understand trochanteric bursitis.

Causes

To explore trochanteric bursitis, we must first understand its causes. Trochanteric bursitis is caused by physical trauma to the hips, damage to the hip tissues due to physical stress. In general, this can result from:

• Hip injuries
• Poor posture
• Repeated exertion of the body
• Surgical complications

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. Thus, trochanteric bursitis may also result from a complication of sports injuries.

Poor posture

Poor posture puts physical 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. Such conditions include scoliosis – a C-shaped or S-shaped curvature to a person’s spine, bone spurs – lumps of bone tissue growths on the surface of the bone, and calcific tendonitis – calcium boney deposits on the tendons. 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.²

Repeated exertion 

Repeated exertion of the body may result from intense or repetitive physical activities, such as lifting heavy boxes, standing, and walking over a long period. The repetitive motions constantly aggravate the trochanteric bursa, leading to a buildup of mechanical stress. Sports that involve repetitive motions, such as running and tennis, 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.

Surgical complications

Trochanteric bursitis is a known complication of total hip arthroplasty, with a direct lateral approach during surgery more likely to cause trochanteric bursitis than a direct anterior approach.^2,3 Surgery may have the unintended consequence of trauma to the hips, due to failure of muscles and tendons to heal properly. Some patients may also experience a limp or altered gait/way of walking 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 trochanteric bursitis after surgery. 

Ageing-related risk factors

The World Health Organisation describes ageing as the accumulation of molecular and cellular damage over time, leading to a gradual decrease in physical and mental capacity as well as a growing risk of disease. This decrease in a person’s health is only loosely associated with a person’s age in years and may directly or indirectly increase a person’s risk of trochanteric bursitis. Risk factors related to ageing include:

• Physical degeneration caused by ageing
• Hip surgeries 
• Previous medical history

Ageing-related physical degeneration

Ageing leads to wear and tear of the body, a major risk factor for trochanteric bursitis. Mechanical stress of the hips builds up over time, particularly when a person regularly performs repetitive physical activities such as lifting heavy objects and running. Additionally, age increases the risk of hip injuries and poor posture, thus increasing the risk of trochanteric bursitis.

Total hip arthroplasty 

As a person ages, the likelihood of them suffering from a geriatric (related to old age) condition increases, as does the possibility of them receiving medical intervention for the condition. Total hip arthroplasty is a surgery in which the damaged bone and cartilage (soft bone) of a patient’s hip joint is replaced with a metal or ceramic prosthetic. This surgery is often recommended for patients suffering from severe hip pain and reduced range of movement, most commonly due to hip osteoarthritis, degeneration of the hip joint cartilage due to old age. Total hip arthroplasty aims to reduce the patient’s pain level and increase their ability to move. A survey published in 2020 indicates over 86% of patients undergoing this surgery feel an improvement in their pain and movement levels, with over 44% of patients describing the surgery results as ‘excellent’. This indicates that total hip arthroplasty is an effective treatment method with a high success rate. 

However, surgical complications are an inevitable possibility of all surgeries. Trochanteric bursitis is a common complication of total hip bursitis, with an incidence rate between 3-17%.² Most patients make a complete recovery with conservative (non-surgical) treatment methods; thus, post-surgical trochanteric bursitis is not considered a sign of surgical failure. 

Previous medical history

People who previously suffered from hip joint disorders are at higher risk of trochanteric bursitis. A study investigating the long-term effects of greater trochanteric pain syndrome, which trochanteric bursitis is grouped under, reveals that people who were previously diagnosed with greater trochanteric pain syndrome are twice as likely to be re-diagnosed with this condition later in life. Additionally, pre-existing conditions which affect the shape of a patient’s hips, spine, and/or legs increase the risk of trochanteric bursitis. Some of these conditions, including bone spurs and calcific tendonitis, may be caused by ageing-related wear and tear of the bone and tendons. 

Symptoms and challenges

Living with trochanteric bursitis comes with inevitable challenges. The main symptom of trochanteric bursitis is 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. 

This pain may increase with movement, particularly when standing from a seated position and/or climbing stairs. More pain may also be felt if the patient lies on their affected side at night, limiting the patient’s range of movements. If you have hip pain that doesn’t go away after a few days of rest, it may be best to consult a doctor for advice. 

Diagnosis

Doctors usually diagnose trochanteric bursitis through a physical examination of the painful areas to differentiate trochanteric bursitis from other common causes of hip pain, such as hip osteoarthritis. This is typically done by asking patients to perform actions such as ‘to put shoes and socks on’, which can be carried out by patients with trochanteric bursitis but not by patients with hip osteoarthritis. Additional imaging tests, including hip X-ray and MRI, may also be used to rule out alternative conditions.¹

Management

If trochanteric bursitis occurs, it can often be treated by conservative (non-invasive) methods, with minimally invasive surgery as a last resort.^1,2 Conservative treatments of trochanteric bursitis include:

• Activity modifications
• Mobility aids
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy
• Corticosteroid injections

If trochanteric bursitis persists even after multiple corticosteroid injections, invasive methods may be considered to remove the inflamed bursa from the patient:

• Laparoscopy (keyhole surgery)

Activity modifications

Avoid physical activities that aggravate the inflamed area, such as standing and walking for long periods, 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. Light and frequent exersise is recommended to preserve fitness and strength.

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.

NSAIDs

Taking non-steroidal anti-inflammatory drugs (NSAIDs), a type of painkiller, helps to manage the inflammation and reduce pain. 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 that reduces inflammation. For cases unresponsive to the above non-invasive treatments, injecting corticosteroid directly to the trochanteric bursa may be able to reduce pain and improve the mobility of patients. Most patients can 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.

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 (also known as laparoscopy) 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 the inflammation of the bursa surrounding the greater trochanter. Ageing increases the risk of developing trochanteric bursitis, either directly through the wear and tear of the body caused by ageing, or indirectly due to medical interventions such as total hip arthroplasty or previous medical history. Challenges caused by trochanteric bursitis include lateral hip pain and reduced range of movement. Most patients recover through rest and conservative treatments, including the modification of physical activities, the use of mobility aids, as well as the application of non-steroidal anti-inflammatory drugs, physical therapy, and/or corticosteroid injections. Non-conservative treatments such as surgery are only considered as a last resort, and are rarely required to treat trochanteric bursitis.