: Hip Replacement Complications | Trochanteric Bursitis
What is it
The term trochanteric bursitis refers to a condition in which the bursa of the greater trochanter becomes inflamed, painful and tender. So what does that all mean?
The trochanteric bursa is a fluid filled sack (the yellow bit - see image right) that acts as a shock absorber and smooths the passage of the iliotibial band (ITB) (the red strap) over the greater trochanter (the chunk of bone to the left of the bursa). If the bursa becomes inflamed, then each time the ITB moves over it will result in pain.
This will happen every time we take a step!
- Repetitive Trauma - this accounts for the majority of incidents. The trauma is caused by the repetitive contraction (during walking or running) of the gluteus medius and/or the iliotibial band. It is quite commonly seen in athlete who run.
- Acute Trauma - any event that results in the patient suffering a severe impact to the outside of their hip such as in a collision or a fall.
- Surgery - any surgical intervention that necessitates cutting into the bursa (a hip replacement being a good example) may increase its sensitiveness post-operatively. As a result it reacts more strongly to minor trauma - even just to the patient sleeping on the operated side.
- Other conditions - such as rheumatoid arthritis, uneven leg length and ITB syndrome may be a cause.
- Spontaneous development - and sometimes there doesn't seem to be an identifiable cause at all - it just happens!
Who does it affect
Far more cases are reported in women then in men. It occurs in adults of any age and there is no evidence that it affects one race more than another.
RateThe rates reported for all different causes varies from as low as 1.9% in men to 15.% in women depending on the researcher.
In relation to primary hip replacement surgery a recent study (Feb 2009) reported that 32 of 689 (4.6%) patients developed a trochanteric bursitis post-operatively.
Symptoms of Trochanteric BursitisThe outside of the hip will feel tender to such a degree that the patient may not be able to sleep on that side.
The pain may radiate down the outside of the thigh but will not reach the foot.
The patient may also experience pain in the hip area when they walk.
Range of movement - the doctor will check the range of movement present - some types of limited movement are particularly associated with a trochanteric bursitis.
Passive external rotation of the hip may result in pain whereas internal rotation will not.
The doctor will examine for point tenderness over the greater trochanter. This is normally done by pressing down with a single finger.
He may also palpate the region, which may cause pain to radiate down the outside of the thigh.
X-rays and MRI can be used to show tears and any swelling present.
Trochanteric Bursitis Treatment
TimeGiving the bursa time to heal is important and it is therefore essential to avoid the types of activity that may stress it more.
Non-Steroid Anti-Inflammatory Drugs
NSAIDs will help reduce swelling and the pain associated with it.
Icing the Injury The use of ice (suitably wrapped) on the site will help reduce the amount of pain. Ice is particularly effective after exercise as it will help prevent the bursa from swelling.
A steroid injection can be given directly into the inflamed area and is very effective. This may also help clear up and doubts about the diagnosis.
Physiotherapy is an important aspect of treatment. In particular stretching the ITB can relieve tension and reduce friction. Other exercises may be given to strengthen the hip muscles. These are particularly useful for hip replacement patients whose hip muscles may have been weakened as a result of the procedure.
GaitWalking with the feet pointing outwards (just a bit more than usual) will help take the strain and give the bursa time to heal.
In rare case a bursectomy may be performed - that is the bursa may be taken out. This can be done arthroscopically. The surgeon will take this opportunity to repair any tears in nearby muscles
It is important to wear proper fitting, supportive shoes - if necessary orthotic inserts should be considered. These can either be bought over-the-counter or made to fit your individual size and shape.
The ready-made ones are cheap, certainly compared with the made-to-measure ones but if you think you will be needing them long term then the are worth the investment.
Core body strength
Exercises are important for correct posture as are strong legs so working on these areas may also help and may form part of the rehabilitation programme.