What are the treatment options for hip bursitis?

Hip Bursitis Treatment

Start with conservative management including NSAIDs, physical therapy with stretching exercises, and activity modification; if symptoms persist after 4-6 weeks, proceed to corticosteroid injection into the inflamed bursa. 1, 2

Initial Conservative Management (First-Line)

• Begin with oral NSAIDs such as naproxen 500 mg twice daily for pain relief and anti-inflammatory effect 3, 1, 4

  • Naproxen specifically studied for acute tendonitis and bursitis with onset of pain relief within 1 hour 3
  • Use the lowest effective dose, particularly in elderly patients where unbound plasma fraction increases 3

• Implement relative rest and activity modification to reduce mechanical irritation of the bursa 1, 4, 2

  • Avoid repetitive hip flexion, prolonged standing, and lying on the affected side 4

• Prescribe structured physical therapy focused on stretching exercises of the lower back, sacroiliac joints, and iliotibial band 1, 4

  • Physical therapy should include ice massage and compression as adjunctive modalities 5, 4

• Consider additional treatment modalities including pulsed ultrasound and interferential current for symptomatic relief 5, 4

Second-Line: Corticosteroid Injection

• Administer local corticosteroid injection if conservative measures fail after 4-6 weeks 1, 2
  • Inject 24 mg betamethasone (or equivalent) with 1% lidocaine directly into the inflamed trochanteric bursa 1
  • This approach shows good efficacy for persistent symptoms despite conservative therapy 1, 2

Surgical Management (Rare Cases)

• Reserve surgical intervention for intractable symptoms unresponsive to all conservative and injection therapies 1, 6, 2
  • Options include endoscopic trochanteric bursectomy, iliotibial band release, or subgluteal bursectomy 1, 6
  • Minimally invasive arthroscopic techniques are preferred over open procedures when surgery is necessary 6

Important Clinical Considerations

• Rule out septic bursitis before initiating treatment, as this requires oral antibiotics rather than corticosteroid injection 2

• Even calcific trochanteric bursitis responds to conservative management in most cases, so avoid rushing to invasive therapies 5

• Duration of conservative therapy should be at least 2 weeks of intensive treatment before considering escalation 5

• NSAIDs should be used cautiously in patients with renal impairment (creatinine clearance <30 mL/min), where naproxen is not recommended 3