Hip Bursitis

Hip bursitis is the inflammation of one or more bursae—small, fluid-filled sacs that cushion and reduce friction between muscles, tendons, and bones. In the hip, the two main bursae are the trochanteric bursa (on the side of the hip) and the iliopsoas bursa (in the front of the hip). When these bursae become irritated or inflamed, they can cause pain and limit movement. While the condition is usually not serious, it can cause significant discomfort and affect mobility.

How Common It Is and Who Gets It? (Epidemiology)

Hip bursitis is a common cause of hip pain, particularly among middle-aged and older adults. It tends to occur more often in women than in men and in individuals who participate in repetitive activities such as running, cycling, or climbing stairs. People with leg length differences, prior hip surgery, or conditions like rheumatoid arthritis are also at increased risk.

X-ray of the hip joint and its relation to the trochanteric bursa and iliopsoas bursa.

Trochanteric bursa

The trochanteric bursae is a small sac of fluid present at the side of the hip joint. The bursae allow the smooth gliding between the hip abductor muscles, tensor fascia, and the greater trochanter. The greater trochanter is bony prominence at the upper end of the thigh bone at the side of the hip joint.

Iliopsoas bursa

The iliopsoas bursa helps in the smooth gliding of the iliopsoas tendon over the front of the hip joint. The bursa may get inflamed and cause pain and tenderness. The pain is typically situated in front of the hip joint.

Why It Happens – Causes (Etiology and Pathophysiology)

Bursitis occurs when one or more of the hip bursae become inflamed due to irritation, injury, or overuse. Common causes include:

• Direct trauma to the hip from a fall or impact.

• Repetitive motion from activities like jogging or cycling, which can cause friction over the bursa.

• Inflammatory diseases such as rheumatoid arthritis, which make bursae more prone to swelling.

• Calcium deposits in nearby tendons that irritate the bursa.

• Prior hip surgery or leg length differences, which alter joint mechanics and increase stress on the bursa.

How the Body Part Normally Works? (Relevant Anatomy)

The hip joint is a ball-and-socket joint that connects the thigh bone (femur) to the pelvis. The trochanteric bursa lies between the greater trochanter (a bony prominence on the femur) and the muscles that move the hip. The iliopsoas bursa sits in front of the hip joint and allows smooth gliding of the iliopsoas tendon. These bursae reduce friction during movement, allowing pain-free motion of the hip and leg.

What You Might Feel – Symptoms (Clinical Presentation)

Patients with trochanteric bursitis usually feel sharp or aching pain on the side of the hip that may spread down the thigh. Pain often worsens with walking, climbing stairs, or lying on the affected side.
Patients with iliopsoas bursitis typically feel pain in the front of the hip or groin. The pain may worsen when lifting the leg, walking uphill, or rising from a chair. In both types, discomfort is often worse at night.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis begins with a medical history and physical examination. The doctor will check for tenderness and reproduce the pain through specific movements. Imaging studies such as X-rays, CT scans, or MRI may be used to rule out other conditions like arthritis, fractures, or tendon injuries. Ultrasound can also help visualize inflammation in the bursa.

Classification

Hip bursitis is classified based on the affected bursa:

• Trochanteric bursitis – Involves the outer side of the hip near the greater trochanter.

• Iliopsoas bursitis – Involves the front of the hip near the groin.
  Some patients may have both types at once, especially if hip mechanics are abnormal.

Other Problems That Can Feel Similar (Differential Diagnosis)

Other conditions that can mimic hip bursitis include hip osteoarthritis, tendonitis, labral tears, lower back disorders, and referred pain from the spine or pelvis. Careful examination and imaging help differentiate these conditions.

Depo-Medrol used as a steroid shot in cortisone injection.

Treatment Options

Non-Surgical Care – Most cases respond well to conservative treatments:

• Rest and modification of activities that worsen symptoms.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for short-term relief.

• Ice application to reduce inflammation and soothe pain.

• Physical therapy to improve flexibility, strengthen surrounding muscles, and correct gait or posture issues.

• Cortisone injections combining a steroid and local anesthetic (such as lidocaine) can provide lasting relief by reducing inflammation. Injections may be repeated if symptoms return.

Surgical Care – Surgery is rarely needed but may be considered for persistent cases that do not improve with conservative measures. Using minimally invasive arthroscopic techniques, the surgeon removes the inflamed bursa through small incisions. Patients can usually walk the same day and recover quickly.

Recovery and What to Expect After Treatment

Most patients improve within weeks of starting treatment. Pain relief from steroid injections may occur within a few days and last for months. Physical therapy helps restore strength and flexibility, reducing recurrence risk. Recovery after arthroscopic surgery is usually brief, with most patients returning to normal activities within a few weeks.

Possible Risks or Side Effects (Complications)

Potential complications include temporary soreness after injections, infection, bleeding, or, rarely, recurrence of bursitis. Long-term use of NSAIDs may cause stomach irritation or ulcers, so these medications are used carefully and for short periods.

Long-Term Outlook (Prognosis)

The prognosis for hip bursitis is excellent. Most patients recover fully with non-surgical treatment. Maintaining muscle strength and flexibility around the hip greatly reduces the chance of recurrence. Chronic cases may need periodic treatment or lifestyle modification.

Out-of-Pocket Costs

Medicare

CPT Code 20610 – Bursa Injection or Aspiration (Corticosteroid or Anesthetic Injection to Hip Bursa): $15.12

CPT Code 27062 – Open Trochanteric Bursectomy (Surgical Excision of Inflamed Trochanteric Bursa): $108.70

Medicare Part B generally covers 80% of the approved cost for these procedures once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield typically cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved procedures. These plans work alongside Medicare to fill the coverage gap and lower your financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it serves as a secondary payer. These plans usually cover any remaining coinsurance or small deductibles, which generally range between $100 and $300, depending on your plan and provider network.

Workers’ Compensation

If your trochanteric bursitis or hip inflammation is work-related, Workers’ Compensation will cover all associated medical expenses, including injections, surgery, rehabilitation, and follow-up visits. You will not have any out-of-pocket costs, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your hip bursitis developed due to an automobile accident or trauma, No-Fault Insurance will typically cover the total cost of treatment, including injections or bursectomy. The only potential out-of-pocket cost may be a small deductible or co-payment, depending on your insurance policy.

Example

Linda Walker was treated for chronic hip pain caused by trochanteric bursitis. She first received a bursa injection (CPT 20610) with an estimated Medicare out-of-pocket cost of $15.12. When symptoms persisted, she underwent an open trochanteric bursectomy (CPT 27062) with an estimated out-of-pocket cost of $108.70. Because Linda had supplemental insurance through AARP Medigap, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for either procedure.

Frequently Asked Questions (FAQ)

Q. Is hip bursitis serious?
A. No. It’s usually a benign condition that responds well to rest, medication, or injections.

Q. Can I walk with hip bursitis?
A. Yes, but avoid overexertion. Gentle movement is encouraged, but stop if pain worsens.

Q. How long does recovery take?
A. Most people feel better within a few weeks, though some may need several months for full recovery.

Summary and Takeaway

Hip bursitis is a common, treatable cause of hip pain caused by inflammation of the bursae that cushion the joint. Most patients improve with rest, medication, and physical therapy. For persistent cases, a steroid injection or minimally invasive surgery may be needed. Maintaining hip strength and flexibility helps prevent recurrence.

Clinical Insight & Recent Findings

A recent study highlighted that ultrasound-guided corticosteroid injections provide faster pain relief and longer-lasting benefits compared to landmark-based injections for trochanteric bursitis. The study also found that combining physical therapy with injections yields superior long-term outcomes.

Who Performs This Treatment? (Specialists and Team Involved)

Treatment is typically managed by orthopedic surgeons, sports medicine specialists, or physiatrists. Physical therapists assist in rehabilitation, and radiologists may perform ultrasound-guided injections. Nurses and support staff help with pain management and post-procedure care.

When to See a Specialist?

If hip pain persists for more than two weeks, interferes with daily activities, or does not respond to home care, you should see an orthopedic specialist. Persistent tenderness or swelling near the hip also warrants evaluation.

When to Go to the Emergency Room?

Seek immediate care if you experience sudden severe hip pain after a fall, inability to bear weight, fever with hip swelling, or signs of infection such as redness or warmth at the injection site.

What Recovery Really Looks Like?

Early recovery involves rest and ice application. As pain improves, physical therapy helps restore strength and mobility. Most patients resume light activities within days and normal exercise within weeks, depending on the severity and treatment used.

What Happens If You Ignore It?

Ignoring hip bursitis can lead to chronic pain, stiffness, and weakness. Continued inflammation may affect surrounding muscles and tendons, limiting motion and increasing the risk of further injury.

How to Prevent It?

Preventive strategies include stretching before exercise, strengthening hip and core muscles, using proper footwear, and avoiding repetitive stress on the hips. Maintaining healthy posture and correcting leg length differences also help reduce strain.

Nutrition and Bone or Joint Health

A diet rich in calcium, vitamin D, and protein supports joint and bone health. Hydration and a balanced diet promote tissue repair and reduce inflammation. Avoiding excess alcohol and maintaining a healthy weight lessen joint stress.

Activity and Lifestyle Modifications

Low-impact activities such as swimming, yoga, and walking are ideal during recovery. Avoid running on hard surfaces or sitting for long periods. Gradual return to full activity, guided by a therapist, ensures lasting relief and prevents recurrence.

Do you have more questions?