Regenerative Injection Therapies for Hip Bursitis
Trochanteric bursitis, or hip bursitis, as it is commonly referred to as, is a common orthopedic condition that normally is self-limiting. The condition refers to inflammation of a fluid filled sac (bursa) that sits along the outside of the hip. This area, known as the greater trochanter, is formed from the upper end of the femur bone. This is attachment point for muscles and tendons and is an area where friction may develop. The body’s response to friction is to produce bursa tissue.
What causes bursitis and what are the common symptoms?
Trochanteric bursitis typically develops gradually. Injury to the lateral (outside) part of the hip, an overuse injury such as standing for prolonged periods of time, poor posture, lower spinal related disorders, calcium deposits in the surrounding tendons, a sudden change in a workout or training routine, a leg length discrepancy, and other medical conditions such as rheumatoid disease, gout, or thyroid disease can cause hip bursitis. Bursitis also may develop following a hip replacement.
Pain usually develops along the outside of the hip and may begin to radiate downward. There may be tenderness along the bony ridge that forms the greater trochanter. There may be pain with standing from a seated position or with stair climbing. As the disease progresses, increased stiffness within the hip may lead to a limp. Sufferers of hip bursitis often complain of increased pain at night while lying on the affected side.
Treatment for trochanteric bursitis may include activity modification, rest, non-steroidal anti-inflammatory (NSAID) medication, and physical therapy and corticosteroid injections. As systematic review published by Lustenberger et al (2011) found that as many as 33% of patients treated required a second corticosteroid injection to alleviate symptoms of hip bursitis while some had 5 injections!
Surgical management of trochanteric bursitis may be recommended for those who have tried and failed all of the conservative treatment options and still remain symptomatic.
A 2014 study published by the American Academy of Orthopaedic Surgeons (AAOS), compared a single corticosteroid injection to a single platelet rich plasma (PRP) injection for chronic hip bursitis. Twenty patients were included in each group. Outcomes were measured based on validated outcome questionnaires that looked at pain levels, function, and stiffness. Patients treated with PRP had greater improvements in post-treatment scores and had lasting effect (at 1 year after injection) whereas those treated with a cortisone injection had scores that returned back to pretreatment levels within 3 months. The results of the small study appear promising, but further well controlled studies are needed to fully delineate the effectiveness of PRP injections for hip bursitis.
At present, the medical literature is very limited on studies looking at PRP injections and Prolotherapy for hip bursitis. There are a few case reports about patients being successfully treated with either PRP or Prolotherapy. Both PRP and Prolotherapy appear safe and may offer suffers long lasting relief.
Hip bursitis is one of the most common causes of pain in the adult population. It is normally a condition that can be treated non-surgically for most. Unfortunately, some will not improve with treatment resulting in a chronic condition that is much harder to cure. Regenerative injection therapies such as PRP and Prolotherapy should be considered if clinical improvements are not seen early in the treatment process.
Lustenberger DP, Ng, YV, Best TM, Ellis TJ. Efficacy of Treatment of Trochanteric Bursitis: A Systematic Review. Clin J Sports Med. 2011 Sept: 21(5): 447-453.
Monto RR. Paper #778. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans