The trochanteric bursitis, also known as hip bursitis , is a painful condition often associated with hip replacement surgery. The bursa (Bursa) at the greater trochanter (Trochanter major) plays a crucial role in reducing friction between muscles, tendons, and bones. After hip replacement surgery, biomechanical changes can stress this area, leading to temporary inflammation.

Hip replacement is a proven method for treating coxarthrosis and other severe joint diseases. However, post-operative complications such as trochanteric bursitis can occur, which can delay recovery and affect the quality of life of those affected. This article describes in detail the causes, symptoms, and treatment options.

Frequency and significance of trochanteric bursitis after hip replacement

Statistics: Studies show that approximately 4-10% of patients who receive a hip prosthesis are affected by trochanteric bursitis. It is thus one of the most common causes of pain after a successful operation.

Significance: The disease has significant effects on the mobility of patients. Pain when lying on the affected side, climbing stairs, or during daily activities can significantly limit the quality of life. In addition, chronic inflammation can lead to prolonged complaints.

Causes and risk factors

• Mechanical irritation: After hip replacement surgery, altered biomechanics or malpositioning can lead to increased stress on the bursa.
• Muscle imbalances: Weaknesses or imbalances in the hip musculature can increase the load on the greater trochanter and promote bursitis.
• Postoperative complications: In rare cases, an infection or inadequate healing after surgery can lead to inflammation of the bursa.

Biomechanical changes after prosthesis implantation: After hip replacement, the force transmission to the surrounding soft tissues changes. These mechanical stresses can irritate the bursa.

Prosthesis Positioning: A frequently overlooked factor is the placement of the prosthesis. An incorrect angle of the prosthesis stem or cup can lead to excessive stress on the trochanter area.

Additional Risk Factors:

• Obesity: Higher body weight increases the strain on the hip region.
• Activity: Sports activities with high demands on the hip can inflame the bursae.
• Soft tissue problems: Shortened or inflamed tendons, particularly of the iliotibial tract, can exacerbate symptoms.

Symptoms of Trochanteric Bursitis

Local pain: Typically, pain occurs over the greater trochanter. This pain intensifies with pressure, such as when lying on the side or during certain movements.

Movement restrictions: Patients often report restrictions when climbing stairs or getting up from a seated position.

Distinguishing from other conditions: Trochanteric bursitis must be differentiated from lumboischialgia, piriformis syndrome, or problems with the hip prosthesis itself. Imaging diagnostic procedures are helpful here.

Diagnosis

Clinical Examination: An experienced orthopedist can make a suspected diagnosis through targeted pressure tests and movement checks.

Imaging techniques:

• Ultrasound: Visualization of inflammatory processes.
• MRI: Exact localization of the inflammation.
• X-ray: Exclusion of prosthesis loosening or malpositioning.

Differential diagnoses: Conditions such as tendinitis or insertion tendinopathy can cause similar symptoms.

Treatment Options for Trochanteric Bursitis: Conservative Approaches

Pharmacological Therapy:

• NSAIDs: Pain and inflammation relief.
• Cortisone injections: Targeted treatment of inflammation.

Shockwave Therapy:   Shockwave therapy is a non-invasive method in which high-energy sound waves are applied specifically to the affected area. It can promote healing, alleviate pain, and improve blood circulation in the tissue. This form of therapy is particularly suitable for patients with chronic complaints who do not respond adequately to other conservative measures.

Physiotherapy: Strengthening and stretching exercises reduce the strain on the bursae.

Shoes and aids: Orthopedic insoles can compensate for incorrect loading.

Minimally Invasive and Surgical Treatments (rarely recommended)

When is surgery necessary? In cases of chronic complaints or lack of response to conservative therapies.

Arthroscopic interventions: Minimally invasive removal of the inflamed bursa.

Open surgery: Correction of malalignment or decompression of adjacent structures.

Importance of Prosthesis Positioning in the Development of Trochanteric Bursitis

Biomechanics of the Prosthesis: Correct implantation avoids incorrect loading that can lead to trochanteric bursitis.

Preventive Measures: Modern navigation systems and patient-specific prostheses contribute to better positioning.

Prevention of trochanteric bursitis

Physiological movement patterns: Targeted movement therapy before and after surgery.

Individual Load Control: Avoidance of overloading through gradual increase in activity.

Optimized Rehabilitation: Use of special rehabilitation programs tailored to prosthetic care.

Common Patient Questions

Is trochanteric bursitis permanently curable? Yes, with targeted therapy, the chances of recovery are high.

How long does the therapy take? Typically 1-3 months, depending on the severity.

Summary

The trochanteric bursitis is an inflammation of the bursa over the greater trochanter of the femur. This bursa acts as a cushion between bone and tendons to minimize friction. After a hip replacement, in some cases, such inflammation can occur, leading to pain and limited mobility.

Trochanteric bursitis after hip replacement is a treatable complication. Early diagnosis and individually tailored therapy are crucial to alleviate pain and restore hip function.