Die Bursitis trochanterica, auch als Schleimbeutelentzündung der Hüfte bekannt, ist eine schmerzhafte Erkrankung, die häufig mit der Prothese des Hüftgelenks in Verbindung gebracht wird. Der Schleimbeutel (Bursa) am großen Rollhügel (Trochanter major) spielt eine wichtige Rolle bei der Reduktion von Reibung zwischen Muskeln, Sehnen und Knochen. Nach einer Hüftprothesenimplantation können biomechanische Veränderungen diesen Bereich belasten, was vorübergehend zu einer Entzündung führt.

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 about 4-10 % of patients who receive a Hüftprothese are affected by a Bursitis trochanterica. It is therefore one of the häufigsten causes of pain after a successful operation.

Significance: The condition has serious impacts on the Mobilität of patients. Pain when lying on the affected side, climbing stairs or during everyday Aktivitäten can significantly limit the Lebensqualität. Additionally, a chronic Entzündung can lead to prolonged complaints.

Causes and risk factors

• Mechanical irritation: After the implantation of a hip prosthesis, altered biomechanics or malposition can lead to an increased load on the bursa.
• Muscle imbalances: Weaknesses or imbalances in the hip musculature can increase the load on the greater trochanter and predispose to a bursitis.
• Postoperative complications: In rare cases, an infection or inadequate healing after the operation can lead to inflammation of the bursa.

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

Prosthesis position: A häufig übersehener factor is the placement of the prosthesis. An incorrect angle of the prosthesis stem or the cup can lead to übermäßiger load on the trochanter area.

Additional Risk Factors:

• Obesity: Höheres Körpergewicht erhöht the load on the Hüft region.
• Aktivität: Sportliche Betätigung with high strain on the Hüft can inflame the bursae.
• Soft tissue problems: Verkürzte or entzündete tendons, especially of the Tractus iliotibialis, können worsen the symptoms.

Symptoms of Trochanteric Bursitis

Local pain: Typically pain occurs über dem Trochanter major. These verstärken with pressure load, e., when lying on the side or during certain movements.

Movement restrictions: Patients frequently report limitations when climbing stairs or getting up from sitting.

Differentiation from other conditions: Bursitis trochanterica must be distinguished from lumbosacral sciatica, piriformis syndrome, or problems of the hip prosthesis itself. Imaging diagnostic procedures are helpful here.

Diagnosis

Clinical examination: An experienced orthopaedist can already make a tentative diagnosis through targeted pressure tests and movement assessment.

Imaging techniques:

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

Differential diagnoses: Conditions such as tendon inflammations or insertional tendinopathies can cause similar symptoms.

Treatment Options for Trochanteric Bursitis: Conservative Approaches

Pharmacological Therapy:

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

Shockwave therapy:  The shockwave therapy is a non‑invasive method in which high‑energy sound waves are applied directly to the affected area. It can promote healing, relieve pain and improve blood flow in the tissue. This therapy form is especially suitable for patients with chronic complaints that do not respond sufficiently to other conservative measures.

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

Shoes and aids: Orthopedic insoles can compensate for improper 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 procedures: Minimally invasive removal of the inflamed bursa.

Open surgeries: Correction of malpositions or relief of adjacent structures.

Importance of Prosthesis Positioning in the Development of Trochanteric Bursitis

Prosthesis biomechanics: A correct implantation avoids improper loads that can lead to a 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 the operation.

Individual load management: Avoidance of overexertion by gradually increasing activity.

Optimized rehabilitation: Use of specialized rehab programs tailored to prosthetic care.

Common Patient Questions

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

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

Summary

The Bursitis trochanterica is an inflammation of the bursa (Bursa) over the large trochanter (Trochanter major) of the femur. This bursa serves as a cushion between bone and tendons to minimize friction. After a hip prosthesis it can in some cases lead to such inflammation, which causes pain and movement restrictions.

The Trochanteric bursitis  after a hip prosthesis is a treatable complication. An early diagnosis and individually tailored therapy are crucial to relieve pain and restore hip function.