Hip Bursitis

Hip bursitis is a very common complaint and reason for referral or consultation to an orthopedic surgeon. In order to understand hip bursitis, we first have to discuss what a bursa is. Bursa is a fluid filled sac that form around the bony prominences within our bodies. These fluid-filled sacs are there to protect our bones from rubbing on hard surfaces. The most common places are over the side of the hip, over the knees, and over the elbows on the backside. At times these anatomical structures, which are there to protect us, become inflamed. When they get inflamed or upset, they cause symptoms which can include swelling, tenderness and difficulty with everyday function. The good news is that there is effective treatment.

What Are the Signs and Symptoms of Hip Bursitis?

Many patients will complain of pain over the side of their hip and shooting down the side of their legs, sometimes going to the front of the thigh. This pain is usually worse with sitting, but especially severe when lying on that side. Patients usually say that it started on its own without any significant aggravating factors or trauma.

How Do I Know if I Have Hip Bursitis?

If you are experiencing hip pain consistent enough to bother your daily life, then you should consider asking your primary doctor for a referral to an orthopedic surgeon. Some primary care physicians are comfortable evaluating and diagnosing this, however, we usually recommend referral to an orthopedic surgeon for treatment.

Usually, during the consultation, you will receive a physical examination at which point your orthopedic surgeon will be able to tell you if they feel you have hip bursitis. You may or may not need hip x-rays. MRI imaging is usually not necessary, and neither are CT scans.

What Is the Treatment for Hip Bursitis?

There are multiple treatments for hip bursitis, and we can discuss their differences based on conservative or more invasive methods. Usually, the treatment for hip bursitis can start with simple conservative measures like exercise, which are usually directed by a physical therapist. At times, you will be prescribed a cream or patch that can help with the inflammation. This usually is enough to resolve any mild hip bursitis.

Unfortunately for most patients, by the time they get referred to an orthopedic surgeon, their bursitis is fairly chronic and severe. At this point your orthopedic surgeon will usually recommend an initial injection into the area, which can be done in the clinic with or without ultrasound. This injection usually contains anesthetic medicine to confirm that the injection is in the right position and some steroid which helps the inflammation resolve. Usually, one injection is enough to resolve the problem. On more resistant cases, a combination of all of the above should and will be used.

Very rarely, if severely resistant bursitis does not subside, there are possible surgical treatments. They should be discussed in detail along with their risks and benefits.

What Are the Side Effects or Risks With an Injection in the Office?

Prior to doing an injection, discuss all of your medications with your orthopedic surgeon. It should be pointed out if you’re on any blood thinners, most especially. The procedure is usually performed in the office with local anesthesia. This can be as simple as what’s referred to as cold spray/ethyl chloride or something more invasive like an initial lidocaine injection. Once the area is appropriately anesthetized, a cocktail of anesthetic medicine and steroids are injected into the area. This procedure usually lasts a few seconds.

The main risks associated with this injection are pain at the injection site, some local bleeding, which is usually minimal and infection – the reported infection rate is somewhere around one in 30,000. Some patients with darker skin may experience pigment change at the injection site, although this is rare. Lastly, rarely, some patients may experience loss of natural fat at the injection site, which can leave a cosmetic dimple.

Given the number of benefits that injections offer for bursitis inflammation, we usually feel that the injection is worthwhile.

Risks and When to Call the Office

While the majority of patients will do just fine after an injection. It is important to keep an eye on the injection site to make sure you’re not having any complications.

Patients will typically follow up with our office a month or two later to see how the symptoms are doing, however patients should call us immediately if they experience any of the following potential complications.

A fever of over 101
Worsening pain at the injection sites
Any redness or swelling in the injection site