Mr Freedman - Orthopaedic Surgeon
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Trochanteric bursitis is a relatively common condition that can cause significant pain on the outer aspect of the hip around a prominence on the femur bone called the greater trochanter. It tends to be constant, often tender to touch and its intensity can vary over time.
Who does this affect?
The majority of patients are female, often in their forties or older.
The pain may be caused by a combination of tight fascia lata, an inflammed trochanteric bursa and tendon tears. Occasionally, the lateral hip pain is secondary to a deeper hip joint problem such as hip impingement.
Plain x-rays of the hip are usually normal in trochanteric bursitis. An MRI (magnetic resonance) scan is be useful to investigate for abnormal fluid around the greater trochanter, which may be indicative of a tear or inflammation in one or more of the hip adbuctor tendons. A large tear in these tendons will also be visualised on an MRI scan.
Initial treatment is usually non-surgical. Physiotherapy to improve core-stability, stretching of the fascia lata and localised high frequency ultrasound may be useful. In addition, simple painkillers, anti-inflammatory drugs can be helpful.
Steroid injections into the area of maximal tenderness can often relieve pain but how long such injections last can vary from patient to patient.
Mr Freedman has also utilised PRP (platelet-rich plasma) injections to try to stimulate the inflammed abductor tendons to heal. PRP is generated by centrifuging a sample of the patient’s blood to produce a platelet-rich fluid which is then reinjected at the site of injury. Platelets are full of powerful biological factors that can stimulate and regulate tissue healing.
If patients symptoms do not settle with conservative therapy surgery may be considered. In isolated recalcitrant trochanteric bursitis Mr Freedman may suggest a procedure called an arthroscopic fascia lata release. This can be combined with trochanteric bursa excision or tendon repair if required.