Trochanteric bursitis is an inflammatory condition affecting the bursa, a small, fluid-filled sac that cushions the area around the greater trochanter, the prominent bony point on the outside of the hip. This bursa normally functions to reduce friction between the large tendons and the bone during movement. While total hip replacement (arthroplasty) is a highly successful procedure for alleviating joint pain, developing trochanteric bursitis afterward is a recognized complication. The condition is a source of lateral hip pain that occurs in approximately 4% to 17% of patients following surgery. Understanding the specific causes and established treatment pathways is important for patients experiencing this post-operative discomfort.
Symptoms and Identification
The pain associated with trochanteric bursitis is distinct and usually easy to localize. Patients typically report a deep, aching sensation that originates on the outside of the hip and upper thigh. This discomfort is often accompanied by pronounced tenderness when direct pressure is applied over the greater trochanter.
A hallmark symptom of this condition is pain that worsens when lying on the affected side, frequently disrupting sleep at night. Simple activities like standing up after sitting for an extended period or climbing stairs can also intensify the pain. This pattern of discomfort helps distinguish bursitis from pain originating deep within the hip joint itself, which is often felt in the groin area. Identifying this specific location of lateral pain is the first step toward a correct diagnosis.
The Connection to Hip Replacement Surgery
The development of trochanteric bursitis following hip replacement surgery is directly linked to the mechanical and biological changes introduced during the procedure.
Altered Biomechanics
One of the most significant factors is the alteration in the hip’s overall biomechanics. Even minor adjustments to the leg length or the femoral offset—the distance of the femoral head from the center of the body—can increase tension on the gluteal tendons and the iliotibial band. This heightened tension forces the soft tissues to rub more aggressively over the greater trochanter, leading to irritation of the bursa. Studies have suggested that a greater limb-length discrepancy or a larger increase in femoral offset can contribute to the development of this lateral hip pain. The position of the prosthetic components, particularly an incorrect angle of the socket or stem, can also create abnormal stress patterns on the surrounding soft tissues.
Surgical Trauma and Scar Tissue
Surgical trauma and irritation are also direct contributors, depending on the approach used by the surgeon. The bursa itself may be directly irritated or intentionally excised during the operation to facilitate access to the joint. In some cases, scar tissue forms around the surgical site, which can tether the overlying tendons and lead to chronic friction.
Post-Operative Weakness
Post-operative weakness and changes in gait mechanics play a significant role. The initial recovery phase often involves weakness in the hip abductor muscles, specifically the gluteus medius and minimus. This muscle insufficiency can result in a compensatory gait pattern that places uneven and excessive strain on the trochanteric bursa. Addressing this underlying muscle imbalance is therefore a crucial aspect of preventing persistent inflammation.
Hardware Irritation
In rare instances, the surgical hardware itself can be a source of irritation. Prominent screws, wires, or the edge of the prosthetic stem may impinge on the overlying soft tissues, including the bursa or the adjacent tendons. Although less common, this type of mechanical irritation requires specific investigation using imaging to confirm the exact relationship between the implant and the inflamed tissue.
Diagnosis and Non-Surgical Treatment
Diagnosing trochanteric bursitis after hip replacement relies heavily on a clinical examination. A physician will typically confirm the diagnosis by applying pressure directly over the greater trochanter, which reproduces the patient’s characteristic lateral hip pain. While a physical exam is often sufficient, imaging studies are frequently used to rule out other potential causes of pain.
X-rays can help assess the position of the new hip components and check for any hardware prominence that might be causing irritation. An ultrasound or MRI may be ordered to visualize the soft tissues, confirm the presence of fluid within the bursa, or identify a possible gluteal tendon tear, a condition often grouped under the umbrella of greater trochanteric pain syndrome. This comprehensive evaluation ensures that the treatment is correctly targeted.
Non-surgical management is the highly effective, first-line approach for treating this condition, with a high success rate often exceeding 90%. Initial treatment involves rest and activity modification, which means avoiding activities that exacerbate the friction, such as running or sleeping on the affected side. Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to reduce pain and inflammation in the short term.
Targeted physical therapy is a cornerstone of recovery, focusing on stretching the iliotibial band and strengthening the weak hip abductor muscles. A typical physical therapy program may last between six and twelve weeks to restore muscle balance and proper gait mechanics. If these initial measures fail to provide relief, a corticosteroid injection directly into the bursa is often the next step, providing potent anti-inflammatory effects with clinical improvement seen in a majority of patients.
When is Surgical Intervention Necessary?
Surgical intervention for trochanteric bursitis following hip replacement is uncommon and is typically reserved for cases refractory to non-surgical treatment. This means the pain has persisted despite months of dedicated physical therapy and usually two or more corticosteroid injections. Surgery is only considered if conservative management has failed to provide lasting relief over a period of six months or longer.
If the underlying issue is confirmed to be prominent hardware irritating the soft tissue, removal of that component may be necessary. For chronic bursitis, the surgical procedure involves a bursectomy, which is the removal of the inflamed bursa, often performed using minimally invasive endoscopic techniques. If imaging confirms a significant tear in the gluteus medius or minimus tendons, a surgical repair may be required.