Rethinking Trochanteric Bursitis: Surgical Perspectives and Outcomes in Hip Replacement

Introduction

Trochanteric bursitis has long been thought of as a simple inflammation of the bursa—a small, fluid-filled sac that cushions the greater trochanter, the bony bump on the outer side of your hip. Classic symptoms include a sharp or aching pain on the side of the hip, often aggravated by movement, lying on the affected side, or direct pressure. Traditionally, doctors have treated this pain as the result of swelling in the bursa, recommending anti-inflammatory medications, physiotherapy , and sometimes steroid injections.

But emerging research is challenging this established view. Recent studies, such as one led by Board and colleagues, found that tissue samples from patients undergoing hip replacement surgery rarely showed signs of actual inflammation in the bursa. This discovery is prompting medical professionals to reconsider what’s really behind ” trochanteric bursitis ” and how it should be treated. In this article, we’ll explore these new findings and discuss what they mean for both surgery and recovery after hip replacement .

Looking Beyond Inflammation: What Recent Studies Tell Us

Recent scientific investigations suggest that trochanteric bursitis may not actually be an inflammation-based condition in most cases. When researchers examined tissue from patients with hip pain , they often did not find the expected inflammation. Instead, the pain may result from tendon damage or degeneration near the greater trochanter, or from problems with hip movement and weight-bearing mechanics.

As a result, the term “ trochanteric bursitis ” might not accurately capture what’s really causing the pain for many people. If inflammation isn’t at the root, then treatments that only target inflammation may not be effective. This realization is changing the way doctors diagnose lateral hip pain : they are increasingly using imaging and physical assessments to look at tendon health and hip function, rather than just focusing on the bursa.

For surgeons, especially those planning hip replacements, understanding the true source of pain is critical. Accurately identifying whether the pain is due to bursitis or other underlying problems allows for better surgical planning and improves the chances of a successful outcome. Careful pre-surgical assessment helps minimize the risk of persistent pain after surgery and ensures patients get the most appropriate care.

Surgical Advances and Improving Patient Outcomes

As our understanding of trochanteric bursitis has evolved, so have the surgical strategies for patients with lateral hip pain , especially those undergoing hip replacement . In the past, procedures often included removing the bursa (bursectomy) under the assumption that it was the primary cause of pain. Now, with growing evidence pointing to other structures as sources of discomfort, surgeons are taking more targeted approaches.

For patients with persistent symptoms, trochanteric reduction osteotomy has emerged as an effective option. This procedure reshapes the greater trochanter to improve hip mechanics and relieve pain in those who haven’t benefitted from traditional treatments. The surgical approach aims to reduce the prominence of the greater trochanter without disrupting important muscle attachments, offering a biomechanical solution for stubborn cases of lateral hip pain .

Another innovative procedure is gluteal fascial transposition, which repairs and reinforces the tissues around the hip, particularly the gluteal muscles and tendons. Instead of merely removing the bursa, this surgery focuses on restoring function to the muscles that help stabilize the hip during movement . Outcomes for this technique are encouraging, with studies reporting high success rates, especially in patients with traumatic or idiopathic pain, as well as those with primary hip replacements. However, success is less likely in patients who have had revision hip replacements.

Physical therapy remains a crucial part of the treatment plan, both before and after surgery. Targeted exercises to strengthen the hip abductor muscles—the muscles that move your leg out to the side—play a significant role in supporting recovery and reducing pain. Diagnostic tools and specific physical tests help doctors determine which patients are likely to benefit most from conservative treatments versus surgery.

Long-term studies show that this combination of careful diagnosis , refined surgical techniques , and personalized rehabilitation leads to significant improvements in pain and mobility for most patients. This multi-faceted approach is allowing more people to return to their daily activities with less discomfort and greater confidence.

Conclusion

The longstanding view of trochanteric bursitis as simply an inflamed bursa is changing. We now know that lateral hip pain is often rooted in a more complex interplay of biomechanical and tendon -related issues, not just inflammation. This updated understanding is reshaping how doctors diagnose and treat the problem, particularly in the context of hip replacement surgery .

By embracing advanced diagnostic strategies and employing surgical techniques like gluteal fascial transposition and trochanteric reduction osteotomy, healthcare professionals can better treat the true causes of pain. When combined with tailored physiotherapy programs, these advances are leading to improved outcomes and better quality of life for patients.

As research continues, we can look forward to even more precise and effective ways to address lateral hip pain . Staying open to these new insights ensures that patients receive the best possible care—helping them regain mobility and comfort after hip replacement .