Trochanteric Bursectomy

Why this approach — at MOS

At MOS, the evaluation of greater trochanteric pain syndrome is not limited to the bursa. Dr. Christoforetti assesses the entire peritrochanteric compartment — bursa, gluteal tendons, IT band mechanics, and any coexisting intra-articular pathology — before recommending any surgical intervention.

An MRI (without arthrogram, for peritrochanteric evaluation) assesses bursal volume, gluteal tendon signal, and any evidence of tendon tearing. Patients with large or complete gluteal tendon tears are counseled that tendon repair — not bursectomy alone — is the more appropriate procedure and the one more likely to provide lasting relief.

Trochanteric bursectomy in isolation is most appropriate for patients with confirmed bursal disease and largely intact gluteal tendons. In cases where both are pathologic, the procedures are combined efficiently in the same setting.

Patients in Bethesda and across Montgomery County who have been receiving repeated cortisone injections without lasting relief are encouraged to discuss whether a definitive evaluation — including tendon assessment — is warranted.

Who is a candidate?

Indications

• Confirmed trochanteric bursitis or GTPS with persistent lateral hip pain despite appropriate conservative care
• Failure of at least 2–3 cortisone injections and a structured physical therapy program lasting 3–6 months
• Pain that limits sleep (lateral lying on the affected side), walking, stair climbing, or exercise
• MRI or ultrasound confirming significant bursal thickening, fluid, and/or peritrochanteric inflammation
• Absence of a large gluteal tendon tear that would require separate repair (though bursectomy may still be performed alongside repair)

Contraindications

• Trochanteric pain with an untreated intra-articular hip source (labral tear, FAI) — the intra-articular problem must be addressed first or simultaneously
• Mild or improving symptoms — conservative management has high success rates (> 90%) and should be thoroughly exhausted
• Active skin infection over the proposed surgical site
• Significant medical comorbidities that increase surgical risk

Conservative Treatment First

Greater trochanteric pain syndrome responds to conservative care in the large majority of patients. Physical therapy focusing on hip abductor and external rotator strengthening, IT band flexibility, core stability, and activity modification is the first-line treatment and resolves symptoms in many patients over 6–12 weeks.

Cortisone injection into the trochanteric bursa under ultrasound guidance is a reliable short-to-medium-term treatment — it typically provides significant relief for several months, though recurrence is common. Extracorporeal shock wave therapy (ESWT) has also shown benefit for refractory GTPS. Orthotics that correct leg length discrepancy or biomechanical factors contributing to IT band tension may help selected patients.

Surgery is reserved for the minority of patients with truly refractory symptoms — those who have had multiple injections without lasting relief and have failed a dedicated physical therapy program.

The procedure

What Is Trochanteric Bursectomy?

Trochanteric bursectomy is a minimally invasive outpatient procedure that removes the inflamed trochanteric bursa — a fluid-filled sac over the greater trochanter of the hip — when it has caused persistent lateral hip pain that has not responded to conservative treatment including injections and physical therapy. It is often performed alongside gluteus medius tendon repair.

The greater trochanteric bursa is a thin, fluid-filled sac that sits between the greater trochanter (the large bony prominence on the outer upper thigh) and the overlying iliotibial band. Its normal function is to reduce friction as the IT band slides over the trochanter during walking. Greater trochanteric pain syndrome (GTPS) is the clinical syndrome of lateral hip pain arising from the peritrochanteric space, which may involve the bursa, the gluteal tendons, or both.

Historically, the condition was called "trochanteric bursitis" and assumed to be primarily a bursal problem. More recent understanding recognizes that the bursa becomes inflamed secondary to underlying gluteal tendon pathology in many cases — particularly partial tears of the gluteus medius tendon. The bursa swells and thickens in response to tendon damage, friction, and mechanical irritation. As a result, the correct surgical evaluation must assess both the bursa and the overlying tendons.

Trochanteric bursectomy removes the inflamed bursal tissue through small arthroscopic portals in the peritrochanteric space — between the IT band and the greater trochanter. It does not require opening the hip joint. Most patients are discharged the same day.

What Happens During Trochanteric Bursectomy?

Trochanteric bursectomy is performed at an ambulatory surgery center under general anesthesia with a nerve block for post-operative pain management. The patient is positioned in the lateral decubitus (side-lying) position with the affected hip facing up.

Portal Placement Two to three small portals (5 mm each) are placed in the skin over the greater trochanter. These peritrochanteric portals are distinct from intra-articular hip arthroscopy portals and do not enter the hip joint capsule. A small amount of fluid is used to maintain visualization in the peritrochanteric working space.

Bursal Debridement The arthroscope is inserted into the peritrochanteric space — the area between the greater trochanter and the overlying iliotibial band. The inflamed bursal tissue is identified and debrided or excised using a motorized shaver. The shaver removes the thickened, inflamed bursa systematically while preserving the underlying gluteal tendons and the overlying IT band.

Gluteal Tendon Assessment Critically, while in the peritrochanteric space, the surgeon directly inspects the gluteus medius and minimus tendon insertions on the greater trochanter. If a partial or complete tendon tear is identified that was not apparent on pre-operative imaging, it is repaired at the same setting using suture anchors. This is an important step — performing bursectomy without addressing an underlying tendon tear may lead to suboptimal or incomplete relief.

Closure Portal sites are closed. Total operative time for isolated bursectomy is typically 30–45 minutes. When combined with gluteal tendon repair, the total time increases.

Recovery timeline

Frequently Asked Questions