Recommended Treatment for Hip Bursitis (Trochanteric Bursitis)
Start with conservative management including NSAIDs, activity modification, and physical therapy focused on hip strengthening and iliotibial band stretching; if symptoms persist after 4-6 weeks, proceed to corticosteroid injection into the inflamed bursa. 1
Initial Conservative Management (First 4-6 Weeks)
Non-Pharmacological Interventions
- Rest and activity modification to reduce mechanical irritation of the bursa 1, 2, 3
- Physical therapy with structured exercises targeting the lower back, sacroiliac joints, hip stabilizers, and iliotibial band stretching 1, 3
- Ice massage applied to the lateral hip for acute symptom relief 4, 3
- Pulsed ultrasound and electrical stimulation (interferential current) as adjunctive physical therapy modalities 4, 3
Pharmacological Treatment
- NSAIDs at the lowest effective dose for anti-inflammatory effect and pain control 1, 2, 3
- Consider compression and elevation principles where applicable 3
Second-Line Treatment for Persistent Symptoms
Corticosteroid Injection
- Inject 24 mg betamethasone with 1% lidocaine (or equivalent) directly into the inflamed trochanteric bursa for patients who fail conservative therapy after 4-6 weeks 1
- This intervention is appropriate for prepatellar and trochanteric bursitis specifically 2
Important caveat: Do not inject corticosteroids into the retrocalcaneal bursa, as this may adversely affect Achilles tendon biomechanical properties 2
Surgical Management for Refractory Cases
Indications for Surgery
- Intractable symptoms despite exhaustive conservative management including rest, NSAIDs, physical therapy, and corticosteroid injections 1, 5, 2
Surgical Options
- Endoscopic trochanteric bursectomy with iliotibial band release as the preferred minimally invasive approach 5
- Alternative procedures include open iliotibial band release, subgluteal bursectomy, and trochanteric reduction osteotomy 1
- Recent advances in hip arthroscopy allow for improved minimally invasive techniques with good patient outcomes 5
Treatment Algorithm
- Weeks 0-4: NSAIDs + activity modification + physical therapy (hip strengthening, iliotibial band stretching, lower back/SI joint exercises) 1, 3
- Weeks 4-6: Add ice massage, ultrasound, and electrical stimulation if symptoms persist 4, 3
- Week 6+: Corticosteroid injection (betamethasone 24 mg + lidocaine 1%) if conservative measures fail 1
- After failed injection: Consider surgical consultation for endoscopic bursectomy if symptoms remain refractory 5, 2
Special Considerations
- Calcific trochanteric bursitis can still respond to conservative management even with radiographic evidence of calcification, so attempt a 2-week intensive conservative trial before considering invasive therapies 4
- Obesity may be a contributing factor and should be addressed as part of comprehensive management 4
- Most patients respond successfully to nonsurgical management, making surgery necessary only in rare, recalcitrant cases 1, 2