What is the treatment for hip bursitis?

Treatment for Hip Bursitis

The treatment for hip bursitis should begin with conservative measures including rest, ice, NSAIDs, and physical therapy, with corticosteroid injections reserved for cases that don't respond to initial treatment. 1

Diagnostic Approach

• Radiographs should be obtained first to rule out other causes of hip pain such as arthritis or bone abnormalities 1
• Ultrasound is useful for examining soft tissue structures around the hip for specific diagnoses such as trochanteric bursitis 1
• MRI may be considered if diagnosis remains unclear or to evaluate associated tendon pathology 1

Treatment Algorithm

First-Line Treatment

1. Rest and Activity Modification

   • Reduce activities that aggravate symptoms
   • Avoid direct pressure on the affected area
   • Temporary reduction in physical activity 1

2. Ice Application

   • Apply ice for 15-20 minutes several times daily
   • Particularly effective after activity or when pain flares

3. NSAIDs

   • Naproxen 500mg twice daily (or 250mg every 6-8 hours) for acute pain 2
   • Lower doses (500-1000mg/day) for longer-term management 2
   • Use the lowest effective dose for the shortest duration to minimize side effects

4. Physical Therapy

   • Structured exercise program focusing on:
     • Hip strengthening exercises (particularly abductors)
     • Stretching exercises for hip muscles
     • Core strengthening
   • Exercise should be tailored to the patient's functional goals 1

Second-Line Treatment

If symptoms persist after 2-4 weeks of first-line treatment:

1. Corticosteroid Injection

   • Ultrasound-guided injection into the affected bursa 1
   • Provides significant relief in approximately 80% of patients 3
   • May be combined with local anesthetic for diagnostic and therapeutic purposes 1
   • Some patients (approximately 45%) may require multiple injections 3

2. Advanced Physical Therapy

   • Progressive loading exercises
   • Gradual return to sport-specific activities 1
   • Focus on correcting biomechanical issues that may contribute to bursitis

Third-Line Treatment

For refractory cases (approximately 20% of patients) 3:

1. Surgical Intervention
   • Bursectomy may be considered for recalcitrant trochanteric bursitis 4
   • Particularly when associated with significant functional limitations
   • More likely to be necessary in younger patients and those with leg-length discrepancy 3

Special Considerations

• Weight Management: Weight reduction is recommended for overweight or obese patients to reduce mechanical stress on the hip 1
• Assistive Devices: Consider walking aids (cane or crutches) to reduce weight-bearing on the affected side 1
• Footwear and Orthotics: Proper footwear and possibly orthotic insoles to correct biomechanical issues 1
• Post-Arthroplasty Bursitis: May require more aggressive treatment as it can be more resistant to conservative measures 3

Pitfalls and Caveats

• Differentiation between bursitis and gluteus medius tendinosis may be difficult, and the two conditions may coexist 1
• Failure to identify and address underlying biomechanical issues may lead to recurrence
• Iliopsoas bursitis can sometimes be associated with femoral neuropathy, requiring more urgent intervention 5
• Corticosteroid injections should be limited in frequency (typically no more than 3-4 per year) to avoid tendon weakening and other complications
• Persistent symptoms despite appropriate treatment should prompt re-evaluation for other causes of hip pain

By following this structured approach to treatment, most patients with hip bursitis will experience significant improvement in pain and function without requiring surgical intervention.