What is the treatment for hip bursitis?

Treatment of Hip Bursitis

The treatment of hip bursitis should begin with conservative measures including rest, NSAIDs, and stretching exercises, followed by corticosteroid injections if symptoms persist. 1

Conservative Management (First-Line)

Non-Pharmacological Approaches

• Rest and activity modification to reduce inflammation and prevent further irritation of the bursa 1, 2
• Physical therapy with stretching exercises focused on the lower back and sacroiliac joints to improve flexibility and reduce pressure on the affected bursa 1, 3
• Local heat or cold applications for symptomatic relief 4, 2
• Weight loss for overweight or obese patients to reduce pressure on the hip joint 4
• Walking aids such as canes may be helpful to reduce weight-bearing on the affected hip 4

Pharmacological Treatment

• NSAIDs are recommended as first-line pharmacological treatment for pain and inflammation 5, 3
  • Naproxen 500 mg twice daily is an effective option, with dose adjustments based on individual response 5
  • Use the lowest effective dose for the shortest duration to minimize adverse effects 5
• Acetaminophen (up to 4g/day) may be used as an alternative first-line oral analgesic for patients who cannot tolerate NSAIDs 4

Second-Line Treatment

Corticosteroid Injections

• For patients whose symptoms persist despite conservative therapy, corticosteroid injection into the inflamed bursa is highly effective 1, 3
• Typically involves injection of betamethasone (or equivalent) with lidocaine directly into the trochanteric bursa 1
• Should be guided by ultrasound or x-ray for accurate placement 4

Physical Therapy Modalities

• Intensive pulsed ultrasound therapy has shown effectiveness even in cases with calcific trochanteric bursitis 6
• Iontophoresis may be beneficial as part of a comprehensive physical therapy program 6
• Structured rehabilitation programs can facilitate the healing process 2

Treatment for Refractory Cases

Surgical Options

• For patients with persistent symptoms despite exhaustive conservative treatment and injections, surgical intervention may be considered 7, 3
• Surgical options include:
  • Endoscopic or open trochanteric bursectomy to remove the inflamed bursa 7
  • Iliotibial band release to reduce tension on the greater trochanter 7
  • In rare cases, trochanteric reduction osteotomy may be necessary 1

Treatment Algorithm

1. Initial Treatment (4-6 weeks)

   • Rest and activity modification
   • NSAIDs (naproxen 500 mg twice daily)
   • Home stretching exercises
   • Ice/heat application

2. If symptoms persist (6-12 weeks)

   • Referral to physical therapy for structured program
   • Corticosteroid injection into the bursa
   • Continue NSAIDs as needed

3. For refractory cases (>3 months with failed conservative treatment)

   • Consider surgical consultation for bursectomy
   • Evaluate for other potential causes of lateral hip pain

Common Pitfalls and Caveats

• Failure to distinguish bursitis from other causes of hip pain such as osteoarthritis, tendinopathy, or nerve pathology 3
• Overuse of corticosteroid injections, which may lead to tendon weakening if administered too frequently 4
• Inadequate physical therapy or premature return to aggravating activities, leading to symptom recurrence 2
• Focusing only on symptom management without addressing underlying biomechanical issues that may contribute to bursitis 1, 2