Trochanteric bursitis is a painful condition that can arise after hip replacement surgery, impacting a patient’s recovery and overall well-being. This inflammation of the bursa, a fluid-filled sac, near the hip joint is a recognized complication following total hip arthroplasty (THA). While hip replacement is a proven method for treating severe joint diseases, post-operative issues like trochanteric bursitis can delay recovery and diminish quality of life. Studies indicate that this condition affects approximately 4-10% of patients who undergo hip replacements, making it one of the more common sources of pain after a successful operation.
Understanding Trochanteric Bursitis
Trochanteric bursitis involves inflammation of the bursa located on the greater trochanter, the prominent bony point on the outside of the hip. Bursae are small, fluid-filled sacs that act as cushions, reducing friction between bones, tendons, and muscles as they move. When this specific bursa becomes inflamed, it leads to discomfort and pain.
The condition often manifests as pain on the outer aspect of the hip, which can be tender to the touch. This discomfort might also extend or radiate down the side of the thigh. Patients commonly experience increased pain when lying on the affected side, climbing stairs, or engaging in activities that involve repetitive hip movement.
Causes After Hip Replacement
The development of trochanteric bursitis after a hip replacement is often linked to changes in the hip’s biomechanics and the surgical process itself. Surgical trauma or irritation to the bursa during the procedure can directly contribute to inflammation. The direct lateral surgical approach, for instance, has been associated with a higher incidence of post-operative bursitis compared to other approaches.
Changes in gait or overall biomechanics following the implantation of a hip prosthesis can alter the force transmission to the surrounding soft tissues, placing increased stress on the bursa. Muscle imbalances or weakness in the hip muscles can further exacerbate this stress, promoting inflammation. Although less common, the formation of scar tissue in the area after surgery may also play a role in the condition’s development.
Diagnosis and Treatment
Diagnosing trochanteric bursitis after hip replacement involves a physical examination and a review of the patient’s medical history. During the examination, a healthcare professional will palpate the area around the greater trochanter to identify tenderness, a key sign of the condition. Imaging studies, such as X-rays, may be used to rule out other causes of hip pain, like implant issues or bone problems.
Sometimes, an ultrasound or MRI may be used to confirm diagnosis or assess soft tissues, though it is often diagnosed clinically. Treatment starts with conservative measures, including rest and ice application to reduce inflammation and pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to reduce pain.
Physical therapy is a common treatment, including stretching and strengthening exercises for the hip muscles. If conservative methods are not effective, corticosteroid injections directly into the bursa may be given to reduce inflammation. While surgical intervention is rare, it may be considered in cases unresponsive to other treatments, which may involve arthroscopic removal of the bursa.
Recovery and Long-Term Management
Recovery from trochanteric bursitis after hip replacement involves rehabilitation and lifestyle adjustments. Following prescribed physical therapy exercises restores hip strength, flexibility, and function. A gradual return to daily activities is recommended to prevent re-aggravation, paying attention to hip movements.
To prevent recurrence, maintaining proper posture and using appropriate footwear distributes weight evenly and reduces hip stress. Modifying activities that exacerbate symptoms, such as prolonged standing or repetitive hip movements, is also beneficial. Managing body weight lessens the load on the hip joint and surrounding structures, reducing recurrence risk. Patients should consult a healthcare professional if symptoms persist or worsen if management strategies are ineffective, as further evaluation or treatment adjustment may be needed.