Hip bursitis, or trochanteric bursitis, involves inflammation of the bursa sac positioned on the outer side of the hip, near the greater trochanter of the femur. This condition typically causes pain and tenderness, making lying on the affected side or walking difficult. A corticosteroid injection is a common treatment, designed to deliver powerful anti-inflammatory medication directly to the inflamed tissue. When this standard procedure fails to provide lasting relief, it signals that the underlying problem is more complex than simple inflammation. This lack of improvement requires re-evaluation of the initial diagnosis and a shift toward more intensive, long-term treatment protocols.
Understanding Why the Injection Might Fail
The most common reason a cortisone injection fails is that the pain is not primarily caused by an inflamed bursa. Lateral hip pain is frequently a symptom of gluteal tendinopathy, a condition involving degeneration or tearing of the gluteus medius and minimus tendons. Since corticosteroids target inflammation, they will not resolve a structural issue like a tendon tear or chronic tendinopathy.
Improper needle placement is another frequent cause of failure. Corticosteroids must be accurately delivered into the bursa sac or the peritendinous space to be effective. If the injection is performed without imaging guidance, the medication may miss the intended target entirely. Injecting the steroid directly into the gluteal tendons can also weaken the tendon structure, potentially worsening the underlying tendinopathy.
In chronic cases, inflammation may be so severe that a single dose of corticosteroid is not strong enough to overcome the entrenched pain cycle. A lack of adherence to post-injection care can also negate the shot’s effect. If a patient immediately returns to irritating activities, the bursa can re-inflame before the medication works fully. The injection’s goal is to create a “window of opportunity” for physical therapy, not to be a standalone cure.
Revisiting Conservative and Advanced Non-Surgical Treatments
A failed cortisone shot necessitates an immediate shift to an intensified physical therapy program, which is the most robust long-term treatment for gluteal tendinopathy. This approach focuses on progressive, therapeutic loading of the hip abductor muscles, specifically the gluteus medius and minimus. The goal is to address the root cause of the problem: muscle imbalance and mechanical strain on the tendons.
Physical therapy should incorporate eccentric strengthening exercises, where the muscle lengthens while under tension, as these are effective for promoting tendon health. Exercises like side-lying leg lifts, single-leg squats, and step-ups gradually build the strength and endurance required to stabilize the hip joint. Full recovery is often slow, requiring consistent effort over several months, but it provides the most durable solution.
A second cortisone injection may be considered only if the patient experienced temporary relief followed by a recurrence of pain. A minimum waiting period of three months is required to protect tissue integrity. Healthcare providers generally limit injections to a maximum of three per year due to the potential for cartilage damage and tendon weakening. If the first injection failed completely, a second one is rarely recommended.
If conservative measures continue to fail, advanced non-surgical injections that focus on healing become the next option. Platelet-Rich Plasma (PRP) therapy involves processing a patient’s own blood to concentrate platelets, which are then injected into the injured area. These concentrated platelets release growth factors that stimulate cellular repair and tissue regeneration in chronically damaged tendons.
PRP is often preferred over corticosteroids for chronic tendon issues because it promotes healing and avoids the tissue-weakening effects of steroids. Another non-steroid option is Extracorporeal Shock Wave Therapy (ESWT), which delivers high-energy acoustic waves to stimulate increased blood flow and cellular activity. These treatments are reserved for patients whose pain has persisted for three to six months despite compliance with a strengthening-focused physical therapy program.
Evaluating Surgical Intervention
Surgery is a final consideration, reserved for patients whose chronic, debilitating pain has failed to resolve after six to twelve months of comprehensive non-surgical management. The persistence of symptoms, despite multiple interventions, indicates a need to address the underlying physical pathology. Surgical intervention is also indicated when imaging confirms a significant, full-thickness tear of the gluteus medius or minimus tendon.
The standard procedure is a minimally invasive arthroscopic trochanteric bursectomy, where the inflamed bursa is removed using small incisions and a camera. Since the primary problem is often tendinopathy, the surgeon frequently performs a concurrent repair of any associated gluteal tendon tears. Addressing both the inflamed bursa and the damaged tendon provides the best chance for long-term resolution of the pain.
The recovery timeline depends heavily on whether a tendon repair was necessary. For a simple bursectomy, patients typically resume light activities within four to six weeks, with a full return to function possible within three months. If a gluteal tendon repair is performed, recovery is longer and more restrictive. Patients may require six weeks of limited weight-bearing before beginning an intensive physical therapy program, with full recovery taking five to six months.