Hip bursitis

Definition

Hip bursitis is an inflammation of one of the bursae surrounding the joint. Bursae are small pads filled with fluid located between soft tissue and bone. Their function is to provide cushioning and soften friction.

The hip joint is surrounded by several bursae (otherwise known as synovial pouches), but only 3 of them are usually inflamed: the acetabular pouch (it has two parts: deep and superficial), the iliac-pectinate, and the sciatic-gluteal pouch.

Anatomical features

The hip joints play a crucial role in everyday physical activity. They are one of the largest and most complex joints that connect the legs to the torso and provide the ability to stand and move while maintaining balance. Any pathological changes affecting them can seriously impair a person’s mobility. One such pathology is bursitis of the hip joint.

The hip joint is a hinge-like joint between the head of the femur and the acetabulum of the pelvis. Inside it, there are several pouch-like structures – synovial bursae – small-sized cavities with fluid, which perform a shock-absorbing function when the joint moves. Inflammation of the bursa is called bursitis.

The hip joint is surrounded by several bursae, but from the point of view of the development of pathologies, only three, the most frequently subjected to inflammation, are of importance:

• acetabular, which is divided into a superficial part and a deep part;
• lumbosacral, also called iliac-pectinate;
• and the most rarely inflamed is the gluteo-sciatic.

The deep part of the acetabular bursa is located between the characteristic protrusion near the neck of the femur (the so-called greater acetabulum) and the attachment point of the gluteus maximus tendon, while the other part is close to the skin, almost above the acetabulum itself.

Bursitis is more common in people aged 40-50. Women are more often affected, especially with acetabular bursitis, because of their pelvic structure: the tubercle of the greater acetabulum is located at a greater distance from the mid-axial line of the body, which increases the load on this protuberance during movement.

Reasons

Bursitis is usually an aseptic (i.e., non-infectious) inflammatory process. It occurs as a result of compression, trauma, or – in a typical case – microtraumatization due to constant overuse.

In addition, bursitis of the hip joint can be caused by:

• joint surgery;
• Infections that have entered the joint bag (especially in arthritis);
• metabolic disorder;
• autoimmune diseases;
• overweight;
• inadequate nutrition of the joint, etc.

Bursitis of the acetabular pouch is the most common. It is more characteristic of women due to the anatomical structure of the female pelvis, which has a larger diameter than the male pelvis.

Bursitis of the iliac-pectinated sac occurs less frequently, and sciatic-gluteal is even less frequently identified.

Skinny people or those who have to sit on hard surfaces for long periods are prone to developing it. It can also occur in other joint diseases, such as reactive arthritis.

Symptomatology and diagnosis

In any hip bursitis, the main symptom is pain, which worsens when the patient lies down or sits down. The thigh may swell, the skin over the inflamed articular bag may become red, and sometimes there is fever and weakness.

However, the nature of the pain will vary depending on which bursa is inflamed. The symptoms of deep acetabular bursitis are pain and tightness in the posterior part of the greater acetabulum. It increases if the patient bends the leg or rotates it inward. But if the leg is withdrawn or rotated outward, the tension in the upper gluteal muscle is relieved, and the pressure on the bursa is reduced. Discomfortable movements of the thigh may cause pain in the posterior surface of the thigh.

The symptoms of superficial acetabular bursitis are pain and inflammation in the area above the acetabulum, which increases with hip extension movements.

Patients with iliac crest bursitis experience discomfort predominantly at the front of the thigh, almost in the groin.

If the sciatic gluteal bursa is inflamed, the area above the sciatic tubercle hurts. In addition, pain spreads over the entire thigh surface at the back, which may resemble the symptoms of a herniated disc.

Therefore, the orthopedic surgeon must perform more than a superficial examination of the patient. The surgeon must carefully collect a medical history, perform palpation, determine the patient’s range of motion, and determine the stability of the hip joint. A referral for an MRI scan is also a good idea.

Treatment

Usually, hip bursitis can be treated with conservative methods.

To do this, you need:

• refrain from activities that cause discomfort, which will allow the bursa to heal better;
• relieve pressure on the painful hip with a cane, crutches, or hip brace;
• use local anesthetics;
• sometimes cortisone injections

If the bursa is significantly swollen, the doctor may decide to aspirate it to relieve discomfort. If the bursa is suspected to be infected, a sample of fluid from the bursa will be analyzed. The bursa should be drained and treated with antibiotics if the hypothesis is confirmed.

In some cases, an inflamed bursa can be surgically removed.

All these treatment options are available in more than 670 hospitals worldwide (https://doctor.global/results/diseases/hip-bursitis). For example, Arthroscopic trochanter bursitis surgery can be performed in these countries at following approximate prices:

Turkey $2.2 K in 14 clinics

Germany $8.5 K in 35 clinics

United States $11.0 K in 15 clinics

Israel $12.3 K in 13 clinics

China $12.3 K in 6 clinics.

Physical therapy for hip bursitis

In aseptic bursitis of the hip joint, physiotherapeutic treatment such as exposure to a pulsed magnetic field can relieve pain syndrome.

It helps control inflammation, which means it reduces pain and relieves swelling. In addition, the pulsed magnetic field accelerates healing2.

Takeaway messages

1. Hip bursitis is an inflammation of one of the bursae surrounding the joint.
2. Causes of inflammation: compression, trauma, microtraumatization, surgery, infections, metabolic disorders, autoimmune diseases, overweight, inadequate nutrition of the joint.
3. Bursitis of the acetabular pouch is the most common and is more common in women.
4. Symptoms of hip bursitis include include pain syndrome, swelling, redness of the skin, fever, and general malaise may also occur.
5. Diagnosis: examination, history taking, palpation, determination of range of motion and joint stability, MRI of the hip joint.
6. Treatment of bursitis is usually carried out with conservative methods: abstaining from activities that cause discomfort, removing the load from the hip joint, using painkillers, and sometimes, cortisone injections.
7. Aseptic bursitis of the hip joint can be successfully treated with magnetotherapy.
8. If the bursa becomes infected, it is drained, and the patient is treated with antibiotics.